SCREENING AND DIAGNOSIS

Diagnostic imaging studies often real one or more of the following ,spinal stenosis, vertebral instability, recurrent or residual disc herniation, scar tissue (fibrosis) and arachnoiditis with clumping of spinal nerve roots. The best imaging tool for assessing for spin instability is positional X-ray. Overall the best imaging method for detecting the soft tissue changes associated with FBS is MRI.  CT and bone scans tend to be more non-specific. A CT/myelogram may be helpful in determining whether there is significant compression of a spinal nerve root.

Conditions which may mimic failed back syndrome include;

• Spinal Infection
• Recurrent or residual disc herniation
• Spinal Tumor
• Hemorrhage
• Pseudarthrosis

CAUSES (PATHOLOGY)

There are many potential causes and contributing factors to the development of failed back syndrome (FBS). They can generally be classified as causes of early onset and late onset. Causes of early onset FBS include post-operative hemorrhage, disc space infection (discitis), bone infection (osteomyelitis) and meningitis. Surgical hardware malposition can also lead to early FBS. A dural tear during surgery or surgery on the wrong level can lead to FBS.  Causes of late onset FBS include central and lateral spinal stenosis, scar tissue (fibrosis), pseudoarthrosis, vertebral instability, residual disc herniation and recurrent disc herniation. Scar tissue can extend to the spinal nerve root. Studies have shown that some degree of FBS (FBS) is noted in 10-15% of operative patients.

Failed back syndrome (FBS) is not really a syndrome but a term which is used to describe the condition of a patient who has not had a successful outcome with spine surgery. FBS occurs more frequently when the wrong patient is selected for spine surgery. This condition has become far to common. There are numerous reasons why a patient may not have a favorable surgical outcome. These reasons include;

• Poor Surgical Selection
• The lesion operated on was not the source of pain
• Spine surgery performed at the wrong level
• Depression
• Impaired ability to recover due to systemic disease
• Injury to the nerve root
• Cerebrospinal Fluid Leak
• Spine infection after surgery
• Failure or lack of fusion and/or pseudoarthrotiss
• Procedure induced vertebral instability (excessive movement)
• Failure of Fixation;
• Excessive Scar Formation (Fibrosis)
• Peripheral nerve compression
• Psychological distress
• Fusion of a vertebrae in an poor position adversely affecting
• The movement of neighboring vertebrae