Failed Back Syndrome (post laminectomy syndrome)

Failed back syndrome (FBS) or post-laminectomy syndrome, refers to chronic back and/or leg pain that is experienced after spine surgery. FBS is, therefore, not so much a specific diagnosis as it is a description. The term implies that the patient still has significant pain despite apparently appropriate surgery. Common symptoms associated with FBS include dull, persistent and aching pain in the back, often at the incision site, and/or legs; sharp, pricking, and stabbing pain in the extremities may also be experienced, especially with movement.

What are the causes?
Many factors can contribute to FBS including residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve root, scar tissue (fibrosis) tethering/pulling on a spinal nerve root, wrong original diagnosis, facet and sacroiliac joint hyper mobility with instability, muscular deconditioning, depression, anxiety, and sleeplessness.  Smoking may predispose an individual to the development of FBS especially following fusions.

What treatment options are available for FSB?
It is important to sort out and diagnose specific pain generators.
Treatments for failed back syndrome may include medications, intermittent steroid injections (once a more specific pain generator is identified), physical therapy, exercise therapy, alternative medicine approaches, manipulation, spinal cord/dorsal column stimulation or pump/catheter implants to deliver pain medications directly into the spine.

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