Defined as persistent back or leg pain following back surgery, failed back surgery syndrome (FBSS) is a broadly defined disorder that negatively affects thousands of patients each year and a problem that spine surgeons seem to address more regularly than ever before.
There is no equivalent term for a condition like failed back surgery syndrome (FBSS) in other medical specialties, Kern Singh, MD, of Midwest Orthopaedics at Rush, in Chicago, told Spine Surgery Today, and therefore the syndrome lends itself to many mischaracterizations about what FBSS is and what it is not, he said.
“The problem with using this broad classification is often the surgery is blamed, but we do not know what the indications for surgery were or the fact that surgery was addressing a particular pathology. Sometimes people undergo back surgery but actually have hip problems, sacroiliac joint problems or something not related to their back,” Singh, a Spine Surgery Today Editorial Board member, said. “They have persistence of pain and blame the spine surgery itself.”
Singh said he does not use the term FBSS unless there is definable evidence that surgery was indicated and it was for the diagnosis for which the patient was operated on.
“You have to make sure the surgery is done accurately. Often I see people diagnosed with FBSS who still have residual stenosis, a nonunion present, or screws or instrumentation that was incorrectly placed. So they have a reason for the persistent pain. It is not just because surgery was done,” he said.
Immediately blaming the procedure when a patient still presents with pain in the back or leg is not FBSS, according to Singh. The main reason spine surgery fails is because a surgeon might not have had a good indication to operate. Frequently patients are operated on who do not need surgery or will not benefit from it. To blame the procedure and say it is FBSS is not true. A better name for that situation is something like “failed indication surgery” and not FBSS, he said.