| One-Minute Clinician

Failed Back Surgery: What You Should Know

Failed back surgery syndrome is a problem that affects about 20 to 40 percent of patients who have had back surgery. There are many reasons for this and a lot of it has to do with the peri-operative and pre-operative work up of those patients. For example, studies show that 60% of the time they did not have the proper diagnosis. Were the behavioral and psychological qualities of the patient looked at? Other factors such whether they’re workers comp or other motives? What is the patient’s medical condition? I think is important to convey to both physicians and patients that surgery is not a panacea. In some situations, it’s indicated and unfortunately your choices are very limited. But in many situations, there are other options, and we need to always look at options that have the greatest benefit with the lowest risk.

Treatment options for failed back surgery syndrome revolve around the diagnosis for the patient. And some diagnostic tools include interventional tools. For example, if we’re worried about certain nerves that are still impinged or irritated or damaged, certain interventional options, different nerve blocks, can help to diagnose whether or not those problems are real. Patients may have other medical issues including things like central sensitization or central pain conditions, and many are not worked up for those conditions and they end up failing these surgeries. So definitely after someone fails, I think it’s time to pause and look at how much organic damage we have now and how many inorganic problems we have. Look at things like anxiety, depression, socioeconomic factors, central pain, and really take time to evaluate those things. There are conservative treatment options like physical therapy, acupuncture, massage, meditation, cognitive behavioral therapy, medications, as well as interventional options to not only diagnose but also to reduce inflammation.  The primary focus should be functional restoration. And to achieve functional restoration, we need to reduce pain, so the patient can engage in more activities, build more strength, and break out of that failed back surgery syndrome naturally, not artificially.

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