Failed Open Spine Surgery (FBSS)

Following open spine surgery, whether it is a fusion, discectomy or laminectomy patients can experience chronic pain in the back and or the arms or legs. These syndromes are often due to identifiable causes but are termed by surgeons and the medical community to be failed back surgery syndrome (FBSS).

Some of the most common causes of failed open back surgery are:

Residual foraminal stenosis due to inadequate exploration of the nerve root during open. Residual spinal stenosis due to failure to appreciate the spinal anatomy during surgery. Painful disc disease due to residual pain emanating from the discs which still retain motion. Spinal instability due to removal of too much of the central disc or removal of too many supporting ligaments.

Treatment Options

Arthroscopic Laser Discectomy

In this procedure the portion of the disc that is causing nerve compression can effectively be removed through a small incision. With the patient awake, a needle is placed into the area of the disc that is producing symptoms. A small incision is made on the patient’s back and the endoscopic tube is inserted.

Using specially adapted endoscopic instruments the diseased disc material is removed and then a laser vaporizes the surrounding problem tissue. A laser is then used to shrink and remodel the remaining disc. A small dressing is used to cover the incision.

Often patients feel immediate relief following this procedure. Rehabilitation begins within hours of surgery, and involves gait training, back or neck support, and walking.

Arthroscopic Laser Foramenoplasty

Foramenoplasty is performed through a small incision in the back, while the patient is conscious under a low-level IV sedation. The narrowed foramen is located with fluoroscopic x-rays, and a guide wire is placed down to the area of disease. Then, a hollow tube is inserted over the wire to the foramen.

The endoscope and surgical instruments are inserted through the tube. The miniaturized television camera on the endoscope provides direct visualization of scar tissue, bone spurs, and diseased disc material. After surgery the patient is prescribed a short course of physical rehabilitation.