Failed back surgery syndrome (FBSS) is a broad term that means persistent pain in the back or leg after back surgery (usually, laminectomy or spinal fusion). Doctors often have a hard time determining what causes persistent pain after surgery. J. Rafe Sales, orthopedic spine surgeon at Providence Spine Services in Oregon, has diagnosed his fellow practitioners with “therapeutic nihilism” concerning FBSS, meaning that many medical professionals simply give up once surgery has failed to address pain.
But patients can’t afford to give up. After incurring the recovery time and expenses of a surgical procedure, ending up with the same or worse pain doesn’t seem like much of an option. Researchers are working to test different ways of addressing FBSS so patients have recourse to something after failed surgery.
Lysis of Adhesions
After spine surgery, it’s possible to develop adhesions in the spine. Adhesions are tough, fibrous bands, similar to scar tissue. These may form in the epidural space, which surrounds the spinal cord. This occurs when fluids hemorrhage into the space during or after the procedure.
Adhesions in the spine can cause persistent back and leg pain. According to one assessment of the literature, adhesions are thought to be responsible for anywhere between 8 and 14% of FBSS cases (see bjr.birjournals.org).
One study sought to assess whether removal of adhesions relieved pain by 50% or more for at least one month in 104 patients with failed back surgery syndrome. Researchers not only wanted to see how many patients experienced positive outcomes, but to assess factors such as age and pain severity for possible correlation with the effectiveness of this treatment method.
Almost half of the patients who underwent lysis, a procedure designed to break up adhesions, experienced positive outcomes. Patients who benefitted were between 59 and 67 years of age, compared to 53 to 61 years of age in the group that didn’t benefit. This suggests that older age increases the likelihood of improvement.
More severe pain scores prior to lysis were associated with not meeting the positive outcomes criteria. Patients who had a positive outcome had initial pain scores of 6-7.3, whereas those who didn’t attain to a positive outcome had scores of 6.9-8. This suggests that lysis is more likely to benefit patients with less severe pain.
See more on this study at www.ncbi.nlm.nih.gov.
Two limitations of this study – the small number of participants and the fact that its follow-up period was only one month – mean that we need to take its results with a grain of salt. That said, it does suggest that lysis of adhesions is a possible solution for many people with FBSS and no other clear options. Patients should be assessed for the presence of adhesions if they haven’t already.
The progress of research provides hope for those in search of FBSS treatment. Find a medical professional who will take your condition seriously and work with you to explore all your options.