When back surgery fails


Failure of back surgeries (including both low back and mid- back)  is a major cause of concern in spinal doctors today. Its extent is such that it has a specific name “Failed Back Surgery Syndrome” (FBSS) by North and Campbell. It Failed Back Surgery Syndrome

I had personally seen many patients with FBSS and most of these patients, to my surprise, had undergone surgery for more than one time. The lack of consistency in the back surgery is also a cause of apprehension in patients with back pain especially when they are asked to go for the surgery.

The big question

Why back surgeries fail?

In recent years, studies had shown that of all patients with acute back, hip, and leg pain, only one percent to two percent suffers from disc herniation and requires surgical intervention i.e. low back surgery. In another study, patients are interviewed by neurologists, 4- 7 years after the back surgery due to prolapsed intervertebral disc (PIVD). As many as 70% had residual low back pain; 23% had severe, permanent low back pain; 45% had residual nerve root pain; 35% patients were under-treated; 14% received disability benefits and 17.2% patients received repeat surgery.


Lack of proper conservative treatment

In cases of low back pain specially with prolapsed intervertebral disc (PIVD) role of conservative pain management is very important. Author finds some points to be of concern and needs attention:

  • Lack of Physiotherapy referral by concerned orthopedics or neurologist in cases of LBP of mechanical origin. Even if a referral is made, then the time mentioned for physiotherapy is generally 5- 10 sitings which is not sufficient for most of the patients.
  • In acute cases, patients are adviced a no exercise, no manual therapy protocol by the referred physician which makes the client apprehended to any physiotherapeutic procedures except electrotherapy modalities. This approach makes the path of complete rehabilitation difficult. This is due to the fact that most common cause of back pain is either the weak trunk and hip musculature or the spinal derangement that can be corrected by exercises and manual therapy respectively.

Unrealistic Expectations

On the part of patient, it is always expected that the treatment will leads to a complete or absolute absence of symptoms with full return to the pre- morbid functionallity. But that is unrrealistic i most of the cases specially in short span. This is true with both conservative and non- conservative treatment appproaches.
So, it must be explained to the patient before the start and during the treatmentthat what are the expected outcomes in terms of pain relief and bodyv functioning after the treatment. This will also helps in easing patients tension as well as improving his compliance to the treatment.

Poor Patient Selection

Although there are many experts spinal surgeons available for the treatment, but there is still a huge gap between the no. of surgeries performed for LBPs and the expert spinal surgeons. This ultimately leads to performance of surgeries, in many of the cases for the conservatively treatable causes of low back pain. These includes Trigger points in quadratus lumborum muscle, trigger points in gluteus minimus muscle, deccreased neural mobility, central sensitization for spinal pain