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Failed Back Syndrome
Failed back syndrome (FBS) is not really a specific diagnosis. It refers to a collection of problems which can each be described by persistent OR recurrent back pain at ANY time after a back surgery. It does not mean that any particular surgery actually failed. Some common examples include adjacent level breakdown, epidural fibrosis (scar) and pseudoarthrosis.
Adjacent segment disease (ASD) is mechanical wear and tear of the spinal level next to a fused level. When a fusion surgery unites two spinal bones together, the everyday forces of running, walking and working are directed to the neighboring disc. Over time, that disc will start to wear out and have the same kind of problems that required the other disc to be fused. Many times, that disc will also require a injections or a fusion.
Epidural fibrosis means scar tissue. Scar formation occurs not only at the skin surface but from the skin to the spine (everywhere that was dissected during the surgery). Some people scar abundantly and it causes problems when the scar strangles the nerves. Scar are not completely preventable or predictable. I employ the most gentle and less traumatic dissections during surgery to attempt to prevent scar formation. Previous scars might indicate how much scarring will occur.
Pseudarthrosis is when the fusion “does not take” meaning the bones did not mend together as planned. Smoking is the biggest reason for this to occur followed by diabetes. When pseudoarthrosis occurs, it is sometimes not painful. When it is painful, then revision fusion surgery is often required. I incorporate the most advanced techniques to prevent and reduce the occurrence of this problem in my surgical patients.