Failed Back Surgery Syndrome
Recurrent herniated disc and scarring after back surgery can produce similar back symptoms of pain and sciatica. Gradually increasing symptoms beginning a year or more after back surgery are considered more likely a result of scar formation. When your pain comes back abruptly at any interval after surgery is more likely due to recurrent herniated disc.
Failed back surgery syndrome is seen in 10-40 percent of patients who undergo back surgery. It is characterized by intractable pain and varying degrees of functional incapacitation occurring after spine surgery.
The clinical features of lumbosacral spinal fibrosis are polymorphic. Lumbar pain and sciatica that become worse, even with minimal physical activities (seen in 60 percent of patients) are the main complaints.
These are most frequent symptoms of failed back surgery syndrome:
- Nocturnal (night time) cramps and distal (hands and feet) paresthesia (loss of sensation or numbness) are common.
- Twenty-five percent of patients have low back pain after surgery without radiculopathy (pain along the nerve root – sciatica).
- Ten percent show cauda equina syndrome (collection of symptomes attributed to compression of lower part of spinal cord) with sphincter dysfunction (problems going to the toilet) and saddle hypesthesia (numbness in the saddle area, lower buttocks and groin).
- Lasegue’s sign (straight leg raise lying on the back) is positive (pain in the sciatic nerve distribution is reproduced between 30 and 70 degrees of passive flexion of the straight leg) in only 20 percent of the cases, but the absence of knee and ankle reflexes is frequent.
Calodney A: Failed Back Surgery Syndrome
Burton AK: Prediction of the clinical source of low back trouble using multivariable modules. Spine, 16:7-14, 1991.
With thanks to Randy V. Curtis, DC at Chiroweb