Post-Surgical Spine Syndrome

Post-surgical spine syndrome – free full-text PMC3205485 – Sep 2011

It is our view that the diagnostic terms post laminectomy syndrome (ICD-9 code 722.8) or failed back syndrome are inaccurate, misleading, can be construed as disparaging, and should be discarded.

Disparaging to whom? I suspect doctors do not like any term that insinuates their methods failed, no matter how true that is.

These authors couldn’t even bring themselves to call this painful syndrome by its *real* name: it’s not called “failed back syndrome”, but rather “failed back surgery syndrome” because, in this case, it is the surgery that failed, not the back.

Failed back surgery syndrome (FBSS) refers to chronic back or neck pain, with or without extremity pain, that can occur if a spine surgery does not achieve the desired result.

We propose that these terms should be replaced with Post-surgical Spine Syndrome (PSSS).

So instead of saying pain is due to a “failed surgery” it is now simply “post surgery” pain, leaving the exact cause of the pain unspecified.

It seems the idea of a “failed surgery” is just too hurtful to the egos of those doing the surgeries, so we have to rename it in a way that conceals what really happened.

Implicit in the terms is that pain and disability following spinal surgery is the result of failed or unsuccessful surgery

Not infrequently, patients report that following surgery, “my leg pain is gone, but my back still hurts.” A significant number of these patients have facet arthropathy, which was likely present before surgery.

As pointed out by Wilkinson, degenerated disk collapses, causes misalignment of the facet joint, which can result in facet pain.

Diagnostic facet medial branch injections may help to determine who may benefit from radiofrequency rhizotomy.

Discectomy may lead to a further collapse of the disk and cause foraminal stenosis and secondary nerve root compression.

The other flaw in the terms is the anatomical inaccuracy.

There are other varieties of spine surgery than laminectomy.

These include

  • discectomy,
  • anterior interbody fusion,
  • posterior interbody fusion,
  • pedicle screw, and
  • other forms of arthrodesis.

Furthermore, new techniques are constantly evolving.

The proposed term of Post-surgical Spine Syndrome encompasses all forms of spinal surgery. It also covers the pathological conditions that existed prior to surgery, as well as conditions that may be related to the surgery, such as nerve root compression or injury, epidural fibrosis, arachnoiditis, adjacent level degeneration, and spinal instability.

It also covers the pathological conditions that existed prior to surgery, as well as conditions that may be related to the surgery, such as

  • nerve root compression or injury, 
  • epidural fibrosis,
  • arachnoiditis, 
  • adjacent level degeneration, and
  • spinal instability.

So they want to muddy the issue with problems that existed before the surgery, likely the problem the surgery was supposed to fix.

Then, when the surgery fails, it is again the patient’s problem that their body didn’t cooperate with the surgeon’s wishes.

The incidence of PSSS may be reduced by a meticulous neurological examination and careful patient selection.

This implies that a “meticulous neurological examination” is not the standard or that patients are not being selected carefully.

That in itself seems a far greater problem than how we choose to name it.

 

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