Failed Spinal Surgery Syndrome

Abstract

Failed spine surgery syndrome is the persistence or recurrence of low back or leg pain or both, after one or more reparative spine surgeries. It is a major expense to society and it is the most common disabling problem of those of working age.

The three main causes of FSSS are inappropriate patient selection and incorrect diagnosis, inappropriate or inadequate surgery, and iatrogenic complications of surgery or diagnostic studies.

Psychologic evaluation seems more predictive of the outcome of surgery than the diagnostic studies or surgical fmdings.

Pain complaints and neurologic fmdings may be ascribable to a pathologic process that was not adequately addressed by the prior surgeon. Foraminal or lateral recess stenosis may be inadequately decompressed, especially when an obvious disc herniation is treated simultaneously. Similarly, previous surgery may not be effective at relieving pain due to retained disc fragments or recurrent disc hun herniation. Also, the initial operation may hove performed at a wrong level or a new herniated disc or further degenerative disease developed at another level of the spine. Some treatment failures occur because the involved nerve root was not adequately decompressed as a result of the lateral disc protrusion or stenosis going unrecognized.