#81 ·
FBSS Failed Back Surgery syndrome.
Dealing with FBSS Failed Back Surgery syndrome can be a real nightmare. It’s essentially when you undergo a procedure hoping for relief, only to find that your pain levels haven't budged—or worse, they've actually gotten worse. So, how do you avoid landing in this situation? It really comes down to being incredibly proactive before you even step foot in the operating room. You need to have some serious conversations with your surgeon about your specific goals and what a "successful" outcome actually looks like for you. Don't be afraid to ask the tough questions or seek a second opinion from another specialist if something feels off. It’s also vital to understand the risks involved. No surgery is a silver bullet, and being realistic about the possibilities helps manage expectations. Ultimately, doing your homework and working closely with your medical team is your best line of defense.
"Failed Back Surgery Syndrome"—or FBSS—is honestly a bit of a misnomer. It isn't actually a specific medical syndrome. Instead, it's just a broad, catch-all term doctors use when a patient doesn't get the results they were hoping for after spinal surgery. Interestingly, you don't see a label like this applied to other fields; there’s no such thing as "failed cardiac surgery syndrome" or "failed knee surgery syndrome." It seems to be a uniquely vague way to describe back surgery outcomes.
Spine surgery isn't an exact science. There are countless variables at play, and even when you have a top-tier surgeon and perfect clinical indications, success rates only hover around 95%. It’s just one of those things where there's always a margin for error.
Spine surgery really boils down to just two main goals:
1) Decompressing a pinched nerve root, or...
Stabilizing a painful joint can be a real challenge.
Unfortunately, back or spine surgery isn't a magic wand that can simply cut away a patient's pain. It only changes the physical anatomy. Because of that, you have to identify a specific anatomical lesion—a clear injury that's likely causing the issue—before any surgical intervention even makes sense.
The single biggest reason back surgery fails is simple: the lesion they actually operated on isn't what's causing the patient's pain in the first place.
Not all back surgeries are created equal when it comes to actually fixing the problem. Some procedures are much more reliable at relieving a patient's pain than others. For instance,
If you’re looking at a discectomy—or maybe a microdiscectomy—to fix a herniated lumbar disc that's shooting pain down your leg, the outcome is usually pretty predictable. It works quite often. But if you're going under the knife because a herniated disc is causing nothing but lower back pain, I have to be honest: the success rate isn't nearly as reliable.
When you're looking at a spine fusion to fix stability issues like spondylolisthesis, the procedure is actually pretty predictable. That said, if you're looking at a spine fusion to deal with multi-level lumbar degenerative disc disease, the odds of actually cutting down on pain aren't nearly as high.
If you want to steer clear of spinal surgery that ends in failure, there really is only one way to go about it: be proactive. The goal should be simple: stick to procedures with a high success rate and ensure we identify any anatomical lesions that can actually be corrected surgically before the operation ever begins.
Beyond the FBSS Failed Back Surgery syndrome mentioned earlier, there are a few other reasons why a surgery might not go as planned or why the pain keeps lingering:
When looking at fusion surgery, there are several key factors to weigh—specifically the risk of non-union (where the bones fail to fuse) or potential implant failure. You might also deal with a transfer lesion at a different level following a spinal fusion—basically, when the adjacent level degenerates and starts generating new pain. Other things to weigh regarding lumbar decompression include recurrent stenosis or disc herniation, insufficient nerve root decompression, pre-existing nerve damage that fails to heal after surgery, or any nerve trauma that happens during the procedure itself.
Thinking about scar tissue.
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Here’s my situation:
I had a Laminectomy and fusion at L5/S1 back in 1972. They made a 30cm incision. Back then, instead of the usual six to nine months of rehab, I was back on the job in just five or six weeks. There was no social safety net to fall back on; if you weren't working, you weren't getting any government assistance. I never regained my full range of motion—I couldn't bend past my knees again. Still, I spent 24 years working heavy manual labor on painkillers. Despite the intense pain, I was lifting up to 150 lbs and juggling three different jobs. I worked as an electrician, often crawling through attics on my stomach or kneeling on my knees. Meanwhile, others who only had minor issues and took disability payouts on the company dime ended up retiring early on disability.
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I retired back in 1992 due to intense work stress. I worked as a work order controller, and honestly, the steel mill paid the price for ignoring my suggestions on how to reduce the pressure. Even now, fourteen years later, I’m still seeing a psychiatrist every six weeks to manage depression, anxiety, panic attacks, and a personality disorder.
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My back issues have been steadily getting worse. I’ve got three degenerate levels in my upper spine now, and my arms have started going numb.
Back in 1997, we had to leave our large 4-bedroom house. I just couldn't manage the upkeep anymore, so on my neurologist's advice, we moved into a two-bedroom unit in a small retirement community—just seven units in total.
Every year, my MRIs showed advanced stenosis and a pinched nerve at L4-L5, along with some minor stenosis at L4-L3. At the same time, they discovered that the burning sensation in my legs—which feels like someone is pressing a hot iron against them—and the stiffness were actually caused by Arachnoiditis. There’s no cure for that.
I consulted three different neurologists, but none of them wanted to operate until I reached the point where I could barely walk 200 or 300 meters. And that is exactly what happened. I went from being someone who could jog half-marathons despite the pain to someone who couldn't even make it from the bed to the garage.
In 2002, I was given a 40-50% chance that things might improve.
After the surgery, things actually got worse. Now the L4 nerve is pinched; they tried two rounds of injections under X-ray guidance, but nothing helps. In the meantime, the L5-S1 area has also deteriorated, and I have a pinched nerve at S1 now too.
The full MRI report shows total lumbar degeneration, which matches my clinical exams. The prognosis is that there won't be any more surgeries, unless I lose bladder or bowel control, which is starting to become a concern.
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So, my current reality involves walking about 300 meters a few times a day. If we are out shopping, I have to sit down, rest, and then start again.
I am honestly grateful we have an automatic transmission with cruise control, because I don't have to constantly press the pedals with my legs.
When we take long trips during our annual vacations, I mostly drive at night because of other health issues. We travel through 62 miles... stop to rest... then get going again.
Our last big trip was to New Zealand back in March/April 2005. We haven't been anywhere since then, not even 249 miles with my younger son, because it would just be too difficult and exhausting.
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The days feel very long. At one point, I'll stand up and move around as much as I can, then I'm back at the computer since that's my main interest and what used to be my "profession," then I try to walk a little again... and it just goes in circles.
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