Failed Back Surgery Syndrome

The Failed Back Surgery Syndrome is an amalgam of complex issues. There are many factors that can lead to a poor post-surgery outcome. Our experience has shown that most failed orthopedic surgical procedures are the result of a poor understanding of the original cause of the patient's complaints. Many surgeries are recommended solely on the basis of an X-Ray, MRI or CT scan, without a good functional examination and without test injections to try to prove the cause of the pain before the surgery. Many surgical procedures are undertaken without a consistent and thorough process including Physical Therapy, manual therapy, assessment of hormone and nutritional factors, and injections, including Regenerative Injection Therapy, which should almost always be considered before a substantially invasive, expensive, and irreversible surgery is performed on any region of the body.

Rare conditions in which delaying surgery could be detrimental, such as impending paralysis or an invasive malignant cancer, may warrant a more rapid decision to proceed with surgery. However, the great majority of spine and sports conditions can be dealt with over time, with a methodical evaluation and treatment process.

Almost every pain pattern that occurs in a patient's history has multiple potential causes; the prospective surgeon has an obligation to make certain that the presumed cause of the pain is the true cause of the pain, as far as is practical. This can only rarely be accomplished without multiple patient visits, multiple thorough examinations, and multiple injection procedures.

Other physician-based factors leading to a poor surgical outcome include poor surgical planning, poor technique, and limited experience on the part of the surgeon for the procedure being undertaken. There are certainly debates in the field of spine surgery regarding whether to simply decompress the spine or to fuse it as well, and which methods produce an optimal outcome. Patient factors may include unknown conditions that produce complications during the surgery or afterwards. Other factors include a recurrence of the disk herniation, a failure of the fusion to form a solid union (a nonunion), epidural and intrathecal scarring from the surgical process, infection, a persistent leak from a tear of the dural sac that surrounds the spinal cord and nerves, and other confounding variables. Taken in total, many things can go wrong when surgery is undertaken.

The risks of surgery are substantial, and the long-term consequences of a poor outcome after surgery are immense. There are enormous financial challenges facing society from these cases. The best way to prevent Failed Back Surgery Syndrome is to thoroughly investigate the pain origin before surgery and reasonably provide a comprehensive treatment plan using non-surgical strategies before ever considering surgery.