The treatment of failed back surgery syndrome (FBSS) can be equally challenging to surgeons, pain specialists, and primary care providers alike. The onset of FBSS occurs when surgery fails to treat the patient’s lumbar spinal pain. Minimizing the likelihood of FBSS is dependent on determining a clear etiology of the patient’s pain, recognizing those who are at high risk, and exhausting conservative measures before deciding to go into a revision surgery. The workup of FBSS includes a thorough history and physical examination, diagnostic imaging, and procedures. After determining the cause of FBSS, a multidisciplinary approach is preferred. This includes pharmacologic management of pain, physical therapy, and behavioural modification .
Many of these patients undergo additional surgeries in order to correct the situation. However, success rates decrease significantly with each subsequent surgery. After unsuccessful surgery, patients present to chronic pain centres with a much more complicated diagnostic picture. If there is a spinal process removal or insertion of implants during spinal surgeries, manipulation of spine cannot be done to those patients. But in certain cases like microdiscectomy, which is a minimally invasive surgical procedure performed on patients with a herniated lumbar disc , our treatment methodology is applicable to these patients and we have found a great success ratio.
A conventional laminectomy done in discectomy surgery involves excision of the posterior spinal ligaments and some or all of the spinous process. Removal of these structures with an open technique requires disconnecting many muscles of the back attached to them.
A laminectomy performed as a minimal spinal surgery is a tissue preserving surgery that leaves more of the muscles intact and spares the spinous process.
Nowadays, many surgeons used to remove the spinous process to ease surgery. Our treatment technique is based on manipulation of spine through spinal gliding. Spinous process is the main key to perform this technique. If spinous process is removed in surgery, then our treatment methodology will not be applicable in FBSS.
In minimally invasive discectomy surgery and micro discectomy, structural damage of the spine is less. Surgeons should avoid removing spinous process. So that, if a failure happens in surgery, then also we have a chance to make the patient back to his normal life through our treatment methodology.
New pain at a level different from the location treated
Inability to Recuperate.
Sharp, Stabbing Back Pain.
Numbness or pain radiating through the lower back into the legs.
Anxiety, depression and sleeplessness.
The assessment and diagnosis of FBSS always begins with eliciting a thorough history and physical examination. The first step involves determining the severity and location of the pain. A temporal relationship between the pain and the surgery should be established. This information, compared to the patient’s pre-surgical pain, can help elucidate a differential diagnosis.
MRI Scan should be done with CT Screening to rule out spinous process removal and to diagnose the present condition of the disc and surrounding structures. If structural or neural damage is more and if there is spinous process removal and spinal fusion with implants, then possibilities of our treatment is less.