How Long After Spinal Fusion Does Continued Pain Signal Fbss

You may have had back surgery with the hopes of getting rid of your pain. You probably expected to feel better after you recovered but instead your surgery didn't bring the relief you were hoping for.

While back surgery can help with certain types of pain, sometimes they aren't always successful and can bring unexpected results. Sometimes the surgery that was supposed to get rid of all your pain can actually cause more pain or can create a new type of pain.

Experiencing some degree of pain and discomfort in the weeks after surgery is expected and considered a normal part of the healing process; some people even experience pain and discomfort for anywhere between three to six months. Most of the time, this pain or discomfort is caused by swelling around the surgery site; and for most people, their pain decreases over time, eventually going away as the swelling goes down and pressure is no longer being placed on the nerves of their spine.

Sometimes people experience pain beyond the normal three to six months healing period. Experiencing persistent or new pain after back surgery could be a sign that you have developed a condition known as Failed Back Surgery Syndrome (also commonly called FBSS or failed back syndrome).

What is failed back surgery syndrome?

So, what exactly does Failed Back Surgery Syndrome (FBSS) mean? The name is a little inaccurate – it's not actually a syndrome.  To put it simply, FBSS is a generalized term used to describe when people still feel pain after the expected healing period of their back surgery.

FBBS is more common than you think with an estimated 40 to 50% of people continuing to experience pain after back surgery¹.

What makes FBSS so difficult to diagnose is the wide range of variables associated with the symptoms. Some people may experience pain right away while others may feel better for a little while, but then notice their pain return later. Some people may experience even worse pain than before their surgery. It's also not uncommon for people to find that their pain has moved to other areas like from their leg pain to back pain or back pain to leg pain or even both.

It's important to point out that developing FBSS doesn't mean that you or your surgeon have failed.  The surgery itself did not fail, rather achieving the complete resolution of symptoms was not successful. Many factors that contribute to developing FBSS may not be avoided or prevented.

What causes failed back surgery syndrome?

While it's difficult to pinpoint the exact reason people continue to experience pain, several potential factors can make FBSS more likely to develop:

• Previous surgical history and medical conditions. Your past surgical history and preexisting medical conditions such as diabetes, autoimmune disorders, anxiety, and depression can influence the development of FBSS.  The risk of developing FBSS also increases with each surgery.
• Lifestyle factors. Stress, diet, sleep problems, weight, and smoking have all been associated with an increased risk of FBSS.
• New pain develops. Your back surgery may have fixed your original symptoms, but new pain in a different part of the spine or a different type of pain can develop. For example, your spine needs to be in a stable and fixed environment to fully fuse after a spinal fusion. If the environment isn't quite right to grow new bone tissue your spine may not fuse correctly. Or during surgery, your spinal nerve is often decompressed. After your surgery, your spine usually recovers and returns to normal. However, for some people, their spinal nerves can stay decompressed causing new pain to develop.
• Reoccurring conditions. Sometimes your original symptoms or diagnosis can return after back surgery. For example, some people will have one disc herniation repaired only to have another herniation happen after recovery.
• History of chronic nerve pain. If you had chronic pain before your back surgery, you may continue to have long-lasting pain even if your surgery corrected the original pain problem.
• A buildup of scar tissue. Scar tissue forming around the roots of nerves or around the surgical site can cause continued pain.  Even if your back surgery is successful, scar tissue can still form.

What are the symptoms of failed back surgery syndrome?

FBSS symptoms may be similar in both intensity and location to the pain symptoms your surgery was originally intended to correct or they could be an entirely new type of pain or discomfort appearing in a completely different location.

FBSS can develop immediately or in the months following your surgery and can include any of the following symptoms:

• Constant throbbing, numbness, tingling, or burning sensation radiating through your arms to your fingers or legs to your toes
• Dull, aching pain in your neck, shoulders, back, buttocks, or hips
• Joint problems
• Severe weakness
• Reduced mobility and range of motion that is different from expected or develops after the recovery period
• Depression and anxiety
• Pain levels like what you felt before surgery
• A return of your original symptoms experienced before surgery
• Experiencing new types of pain or pain in a new location

How is failed back surgery syndrome diagnosed?

A diagnosis of FBSS is usually only made after a comprehensive review of your medical history, imaging results, diagnostic tests, lifestyle and habits, and symptoms. Your pain management provider will also look at the type of surgery you've had. They will pay attention to the results and how your symptoms have evolved after your surgery.

Your pain management provider will also typically order imaging tests to help clarify if you have FBSS. The most used image tests include X-rays, MRI, CT, Discography, EMG, and diagnostic injections.

What are treatment options for failed back surgery syndrome?

• Epidural steroid injections
• Nerve root blocks
• Facet joint injections
• Dissolving your scar tissue
• Physical therapy
• Muscle relaxants
• Opioids
• Anti-inflammatory medications
• Spinal cord stimulation

While you might be tempted to give surgery another try, clinical evidence has actually shown that for people with FBSS another surgery will likely not provide lasting pain relief². Also, clinical evidence suggests long-term use of pain medications isn't effective for people with FBBS².

The strongest evidence for safe and effective long-term pain relief for people who have developed FBSS is high-frequency spinal cord stimulation offered only by HFX^{TM 2}. See how it works:

HFX is the most advanced spinal cord stimulator available and is the only spinal cord stimulator that offers 10,000 Hz high-frequency therapy proven to relieve pain after back surgery ².  In a clinical study used to determine the effectiveness of HFX, 87% of people had previous back surgery and 77% were diagnosed with FBSS. The study found that HFX demonstrated a success rate of nearly 80% for participants^4,5.

Also, HFX has significantly fewer side effects than many other treatment options.

See what physicians are saying about HFX spinal cord stimulation and their patient outcomes:

The next step to finding pain relief

If you are still experiencing pain after back surgery, you may feel like you're right back to where you started. The most important step in treating FBSS is preventing symptoms before they become unmanageable – that's why early detection is so important.

If you'd like to learn more about how to manage your pain after back surgery, the first step is to talk with your pain management provider or find a pain management physician for a consultation.

A pain management provider can help you understand why you are continuing to have pain and help determine if treatment options, like HFX, could be right for you.

Summary

• Pain after the expected healing period is called Failed Back Surgery Syndrome (FBSS)
• Clinical evidence has shown that for people with FBSS another surgery or pain medications will likely not provide lasting pain relief²
• The strongest evidence for safe and effective long term pain relief for people with FBSS is high-frequency spinal cord stimulation offered only by HFX^{TM 2}

Sources

1. Daniell J, Osti, O. Failed Back Surgery Syndrome: A Review Article. 2018 April; 12(2)
2. Kapural L, Peterson E, Provenzano DA, Staats P. Clinical Evidence for Spinal Cord Stimulation for Failed Back Surgery Syndrome (FBSS): Systematic Review. Spine (Phila Pa 1976). 2017 Jul 15;42 Suppl 14:S61-S66. doi: 10.1097/BRS.0000000000002213. PMID: 28441313.
3. Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017 Jul 15;42 Suppl 14:S41-S52. doi: 10.1097/BRS.0000000000002217. PMID: 28505029
4. Kapural L., et al. Novel 10-kHz High-frequency Therapy Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain. Anesthesiology, 123(4)
5. Kapural L, et al. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-month . Results from a Multicenter, Randomized, Controlled Pivotal Trial. Neurosurgery. Published 09 2016.

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