It is a condition called “failed back syndrome” in the medical literature.

This definition is a condition in which there is no satisfactory recovery following lumbar surgery (lumbar hernia surgery, spinal stenosis surgery, etc.).

The failure rate in herniated disc surgery is approximately 8-25% worldwide.

The factors that cause or contribute to failed back syndrome can be listed as follows.

• Misdiagnosis.
• Failure to remove the disc tissue pressing on the nerve fibers during surgery,
• Nerve fiber injuries during surgery.
• Forgetting foreign body in the operation area.
• Fracture mobilization of bones and joints that have become surgically fragile in the surgical field during the recovery period.
• Renewal of herniated disc at the same level. (It usually occurs after a very successful and pain-free 68-month period.)
• Abnormal tissues and adhesions developing in the surgical site. (Granulation tissue and epidural fibrosis.)
• Spinal cord injuries and accumulation of Cerebrospinal Fluid at the surgical site. (This fluid mostly manifests itself as a discharge from the wound site after surgery. It is called CSF fistula.
• Bleeding at the surgical site and pressure on the nerve roots of the blood clot.
• Disturbance in the articulation of the vertebrae from which the herniated disc was removed, loosening, laxity.
• Inflammation of the operation area, infection, discitis due to inflammation, arachnoiditis. (pia arachnoiditis = nerve membrane inflammation.)

From the first day of your surgery, you can feel whether the procedure is “successful” after your herniated disc or narrow canal surgery. The most common causes of failed back syndrome appear immediately after surgery.

If;

If, on the first day of your surgery, a pain that is more severe than before the surgery continues, except for the regional pain caused by the surgical wound, in your hip and leg,

If there is a sharp and constant numbness, burning, cold feeling in your leg even though there is no pain,

If you have noticed weakness in your toes, feet, legs, with or without pain and usually a numbness-burning sensation:

It is highly likely that you are dealing with one of the early signs of failed back syndrome. These reasons are often: “the hernia has not been cleaned sufficiently, nerve fiber damage and blood clot accumulation in the operation area. Even though it is very rare, foreign bodies forgotten in the operation area can also give early findings.

Even if all your complaints are gone after the surgery, CSF fistula is one of the complications that can occur in the relatively early period, that is, within the first week. (=The leakage of fluid from the skin incision and suture area resulting from damage to the Cerebrospinal membrane.)

Deep infections and inflammations such as discitis-Arachnoiditis occur within 2-4 weeks following the surgery. It usually manifests itself with unbearable pain in the lumbar region. The pain is exacerbated by the slightest movement of the patient, even by breathing. Meanwhile, the suture area is usually clean and free of discharge.

The late causes of failed back syndrome, that is, the reasons that occur after the patient has spent quite good and pain-free months:

• Recurrent- herniated disc,
• Slipping or mobility in weakened backbones (Spinal Spondylolisthesis, Spinal Instability),
• Abnormal wound healing tissue development and adhesions. (GranulationEpidural Fibrosis.)

In the treatment of failed back syndrome, a new surgical intervention, that is, surgery, is required for all of the causes, with one or two exceptions.

The general name of this type of surgery is “Revision Surgery.”

Spine Revision Surgery, whatever the reason for the revision, is much more difficult than the first operation of the patient, open to complications, and is a comprehensive and technical intervention.

It is recommended that revision surgery be performed by experienced teams.

It is recommended that the operating room be fully equipped in revision surgeries. Again, “spine stabilization sets, spinal cord adhesives, anti-adhesion drugs, anti-bleeding foam-gel etc.”, which are not included in standard equipment and materials under normal conditions, but must be kept in revision surgeries. Surgery should not be started without providing such drugs and materials.

In contrary standards and practices, the failure rate of “revision surgery” is much higher than the first surgical application.

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