Multiple factors can contribute to the onset or development of FBS. Contributing factors include residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility, joint hypermobility with instability, pseudoarthrosis, infection, depression, anxiety, sleeplessness and spinal muscular deconditioning, An individual may be predisposed to the development of FBS due to systemic disorders such as diabetes, autoimmune disease, and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery.
Common symptoms associated with FBS include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may include sharp, pricking, and stabbing pain in the extremities. The pain may be similar to the pain as before the surgery if the condition is not addressed completely or the pain may be present at the new site if the pathology is different from primary pathology. The patient complains of pain in low back which may be associated with radiation to lower limbs. It may be associated with tingling and numbness in the legs. In the case of infection, a patient will present with a history of fever with or without chills and rigors.
Treatment consists of thorough evaluation and proper diagnosis of the condition leading to pain. To arrive at a proper diagnosis various clinical tests and investigations are done. The time period spends in between the onset of symptoms and the surgical intervention is also important. Delaying surgery affects the surgical outcome.
Conservative: If the clinical evaluation and investigation do not reveal any organic cause of disease, the treatment is conservative. This includes analgesics, anti-inflammatory medications, physical therapy which includes isometric-isotonic exercise to develop core abdominal muscle, transcutaneous electrical nerve stimulation (TENS). Use of epidural steroid injections may be minimally helpful in some cases.
Surgical: If the clinical evaluation and investigation reveal an organic cause of disease, then the particular disease need to be addressed surgically. In the case of persistent or recurrent disc prolapsed the surgery is done to remove the prolapsed disc. Surgery leading to instability will require surgery to stabilise the bone to minimize the mobility and hence pain. In the case of infection at the previous operative site would require debridement and stabilisation of the bony elements.
How to prevent Failed back syndrome:
We at Shanta spine institute believes in prevention is better than cure, so we keep our main emphasis on prevention of the disease more than the treatment. The main cause of failed back syndrome is aging process and unhealthy lifestyle. So we aim to prevent the disease by certain lifestyle modifications which had to be followed regularly. This includes daily 1 hour of exercise, healthy diet which includes lots of fruits and salads, 4-5 litres of water daily and to maintain weight which is normal according to your height and age. The exercise program like swimming, yoga, walking, jogging etc helps to develop core strength and allows us to maintain strength and flexibility of the spine. Lifestyle modifications such as quitting tobacco chewing, smoking cigarette and alcohol is also very important.
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- Vivek Madhukar Puradbhat
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