Diagnosing Failed Back Surgery Syndrome

NYU Langone doctors offer expert diagnosis of failed back surgery syndrome, which involves chronic neck, back, or leg pain that occurs after surgery to correct a back problem, such as spinal stenosis. These common spinal surgeries include decompression to relieve pressure on nerves or the spinal cord, removal of a piece of bone or bone spurs, fusion or removal of discs, and a combination of these procedures.

The spine is composed of 33 bones called vertebrae. These vertebrae are supported and separated by discs, which are made of cartilage and tissue. The discs serve as the spine’s shock absorbing system and protect the nerves. Ligaments and muscles support the spine, enabling it to bend and rotate.

The spine has five segments: the cervical spine, or neck; the thoracic spine, or upper back; the lumbar spine, or lower back; the sacrum, which is located at the base of the spine and forms part of the pelvis; and the coccyx, which is at the very bottom of the spine and is sometimes referred to as the tailbone.

The term “failed back surgery syndrome” is sometimes incorrectly used to describe any pain that occurs after back surgery. Continued chronic pain after surgery may or may not be caused by the procedure’s failure to correct the problem.

For example, a person may have back or leg pain that is actually caused by problems with the hips. This person then may experience a worsening of the original condition after surgery, or this person may have adjacent segment disease, in which he or she experiences pain and problems with a disc that is near the location of a previous surgery.

Surgeons at NYU Langone Orthopedic Center can determine whether lingering pain after surgery is caused by failed back surgery syndrome. Symptoms may include chronic pain in the back, neck, or legs, which can be dull or sharp, aching, burning, or radiating. The pain may continue after surgery or reappear several days or weeks afterward. It can worsen as scar tissue builds in the spinal nerve roots, which extend from the spinal cord.

Medical History

Your NYU Langone doctor asks about your original diagnosis and reviews the surgical report to determine how the procedure was performed.

He or she asks if you are experiencing any heaviness, numbness, or weakness in your arms or legs. The doctor also wants to know about the location and level of your pain and whether it is sharp or dull, ongoing or intermittent, and localized or radiating. Finally, the doctor wants to know if the pain worsens when you stand or walk and if it lessens or disappears when you sit down.

All of this information can help your doctor to pinpoint the cause of your symptoms.

Physical Examination

Your doctor performs a physical exam to determine and evaluate the source of back pain. He or she may look for restricted movement in the spine or neck and weakness in the arms or legs. You may be asked to walk or bend, so that your doctor can view your spine in motion.

During the physical exam, your doctor may perform a neurological evaluation to determine if nerve damage is causing your symptoms. These painless tests may involve using a small hammer to test parts of your body for unresponsive nerve reflexes, which can indicate a pinched nerve.

The doctor may also expose the skin to stimuli, such as a cold metal instrument, to determine if sensation is affected. To assess weakness, which can be caused by nerve compression, your doctor may ask you to move certain muscle groups or push back when he or she puts pressure on your muscles.

Your doctor may also order one or more imaging tests to evaluate the spine.

X-rays and EOS Imaging

Orthopedists often first recommend X-rays, which are two-dimensional images of the inside of the body.

A newer technique called EOS® imaging is a type of X-ray that creates three-dimensional pictures of the entire body, including the spine and nearby soft tissue. It can help determine if a malalignment of your spine is a contributing factor to continued pain and disability. It can help doctors to plan accurate alignment for surgery.

EOS® imaging uses significantly less radiation than a standard X-ray. NYU Langone is one of the first medical centers in New York City and the United States to use this technology.

MRI Scans

Your doctor may recommend an MRI scan, which uses a magnetic field and radio waves to create detailed images of the ligaments, discs, and soft tissue of the spine. This test provides clearer images of soft tissue than a CT scan.

MRI scans can identify bulging or slipped discs, which occur when the inner part of a disc protrudes through the outer rings of the disc—often due to injury or weakness—causing back pain.

CT Scans

A CT scan—which uses X-rays to create cross-sectional, three-dimensional images of the spine—can provide better images of bones than an MRI. It may be used to identify bone spurs, which are growths that can develop on spinal bones, and to determine if you have any fractured bones or displaced vertebrae.

Sometimes, people with pacemakers cannot have MRI scans, so a CT scan is performed instead.

Bone Scans

Sometimes a bone scan is performed to identify changes in bone, such as fractures in the spine. This helps the doctor to determine if a new injury is the cause of your symptoms.

In this test, the doctor injects a substance called a tracer into a vein in the arm. The tracer travels through the blood to the bones, where it collects in areas with changes called “hot spots.” This can help the doctor to identify fractures that aren’t visible on X-rays.

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