Failed Back Syndrome

Failed back syndrome describes chronic back or neck pain with or without limb referral that can occur after surgery that has not achieved the desired outcome. Factors associated with failed back syndrome can be a recurrent disc herniation, adjacent level degenerative changes, muscle deconditioning, facet joint degeneration, sacro-iliac joint degeneration, scar tissue around nerves, failure of fusion called pseudarthrosis and loss of sagittal alignment (loss of normal standing pattern on side profile).
A thorough assessment of the previous history with regards to previous surgical intervention and their indication will be performed and the timing of any ongoing symptoms in relation to those previous surgeries. After a physical examination, further tests will be performed appropriately which may include normal x-rays, MRI, CT or SPECT scans.
Treatment options include further rehabilitation with physiotherapy, targeted injections, be that facet blocks or nerve blocks, or varying medication with referral to chronic pain management team. If there is an identifiable structural issue that can be corrected, then additional surgery may be recommended or if there has been failure of fusion. This will be individualised to the symptoms and scans as assessed. Depending on the nature of the condition then minimal invasive surgery may be an option for this.