How is the Cause of Failed Back Surgery Syndrome Diagnosed?
Do you have any moderate to severe pain or discomfort after back or neck surgery?
If the answer is yes, then you have failed back surgery syndrome or FBSS.
Diagnosing FBSS is easy. Anyone that experiences chronic pain after any type of spinal surgery, as long as the pain is not related to healing, has what is known as “failed back surgery syndrome.” It is broadly defined and covers all types of surgeries and all types of pain.
However, once you have FBSS, the next step is to determine what is causing it, and this can be more difficult. That is why some specialists, like Dr. James L. Chappuis of Spine Center Atlanta, spend years studying failed back surgery causes and symptoms, in order to determine how to diagnose the problem and how to treat it effectively.
Tools to Diagnose Failed Back Surgery Syndrome
There are a number of effective tools for diagnosing failed back surgery syndrome. It is always important to be thorough, but it is especially so for FBSS, since the presence of chronic pain may indicate that something was missed in the initial surgery.
Post Operative Imaging for Failed Back Surgery Syndrome
The diagnosis of FBSS begins with post-operative imaging. Dr. Chappuis and his team need to review what the spine looks like now, in order to see what structural issues may be contributing to the development of chronic pain. Some of the tools used for this type of imaging include:
MRI (Magnetic Resonance Imaging) for FBSS
One of the strongest tools available is magnetic resonance imaging, commonly referred to as an MRI. MRIs use a very strong magnet to activate and measure small magnetic fields inside of the water in your body. They then create an image that allows spine specialists to see an image of the inside of the body. Your surgeon may also add “contrast,” which is a safe dye that enhances the MRI images for a clearer picture.
MRIs provide the most detailed scans currently available. But they require at least a very small amount of water or hydration, which means that they may not be able to provide thorough imaging of areas of the body that do not have water present. MRIs are best used to read areas of soft tissue, and are used to detect:
- Disc Hydration
- Compressed Nerves
- Bulging or Herniated Discs
- Narrowing of the Spine
- Spinal Alignment
- Scar Tissue Formation
Because of how detailed MRI imagery is, it allows surgeons to spot even the smallest of abnormalities, making it one of the most effective diagnostic tools for FBSS.
CT Scans for FBSS
Computerized Tomography scans, also known as CT Scans, are another option for the diagnosis of failed back surgery syndrome. CT scans use the same technology like x-rays, but take the x-rays from multiple angles. A computer then creates a 3-dimensional image from the x-rays, which in turn gives the surgeon an opportunity to see any structural issues in the spine. Like MRIs, CT scans can also use a contrast dye.
CT scans and MRIs are both excellent diagnostic tools. While MRIs tend to have more detailed images, CT scans are effective at creating images of areas of the body where no water is present, something MRIs cannot do. In the spine, this usually refers to vertebrae. CT scans can capture:
- Fractures in the Bone
- Changes in Bone Density
CT scans can also capture changes to tissue, just as MRIs can, but the detail is not quite as strong. Nevertheless, because CT scans do not require a magnet, they are the treatment of choice for those with metal implants, pacemakers, and any manmade technology that could be attracted to magnets.
Bone Scans for FBSS
As the name implies, bone scans are best at capturing detailed images of bones – even more detailed than CT scans. Surgeons like Dr. Chappuis of Spine Center Atlanta to spot small fractures and other bone abnormalities that may occur after spine surgery.
Bone scans use a material called a tracer – a very mildly radioactive substance that is injected into the body, travels through the bloodstream, and eventually binds with bone. The surgeon will then use a tool called a “gamma camera” that is able to take detailed images of the bone by taking pictures of the radiation.
Bone scans are used to spot skeletal problems that may be too minute to find using other postoperative imaging techniques. They may also be used if the surgeon suspects that some type of bone damage or change in structure (such as the development of a tumor) may be responsible for the chronic pain.
Myelograms for FBSS
Myelograms are another alternative to MRIs and are usually used when a patient has a metal implant that makes them less of a candidate for magnetic imagery. They do come with side effects and risks, which is why they are only used when needed, but they provide a visual image of certain areas of the spine that is on par – if not better – than MRIs.
Myelography uses a special dye that is inserted directly into the spinal canal, within the cerebrospinal fluid (CSF). The doctor then uses an X-ray, a CT scan, or possibly even an MRI (in rare cases) to see detailed imagery of the spinal column. It can be used to diagnose almost any cause of failed back surgery syndrome in the cervical or lumbar spine, but is most commonly used to diagnose:
- Narrowing of the Spinal Canal
- Nerve Root Damage or Injury
- Inflammation of Tissues
- Herniated Discs, and More
The images produced by myelography are of very high quality, but the dye does contain some radiation, and it is inserted directly into the CSF, there are risks including severe headache, seizure, and temporary pain. Your doctor will talk to you about all of these risks before performing a myelogram.
Xrays for FBSS
X-Rays are a fast, simple procedure that is usually used to give the surgeon an idea of what they may need to be looking for. They are not as detailed as other forms of postoperative imaging, but they are not meant to be, as they are more of a guiding tool for diagnosis.
X-rays work using a very small amount of electro-radiation that passes through the body at different speeds, which in turn are turned into a type of 2-dimensional image that specialists can review to spot any clearly visible issues.
Although X-rays are frequently used in spine surgery, they are less commonly used in FBSS diagnosis. That said, they may be used to detect:
- Hardware Problems
They may also be used with other procedures, like myelograms.
Selective Nerve Root Blocks (SNRBs) for FBSS
Selective Nerve Root Blocks, or SNRBs, are another common and very effective procedure for diagnosing failed back surgery syndrome/post-laminectomy syndrome. Your surgeon injects a pain reduction medication directly into the spine, usually in the cervical (neck) or lumbar (lower back) portion.
Once inside, the doctor will use a CT scan or a fluoroscope (which is like an X-ray) to monitor the location of the medicine and note which nerves were affected. If the injection offers pain relief, this tells Dr. Chappuis and his team which nerve is the problem nerve.
SNRBs do come with risks, but when performed correctly they are a generally safe procedure that not only helps with the diagnosis – it also provides a small amount of pain relief.
Other Diagnostic Procedures
The best way for Dr. Chappuis and his FBSS specialists to determine the cause of a patient’s failed spine surgery is with advanced imaging that allows them to see what is going on inside of the body. But there are other diagnostic tools as well that may be used, including:
- Thorough Physical Exam
- Review of Health History
- Mental Health Screening
- Review of Pre-Operative Diagnostic Information
Correctly diagnosing the cause of failed back surgery and failed neck surgery requires a thorough examination – in some ways even more so than the initial treatment. Only after determining the correct cause of the back pain can a treatment be recommended.
At Spine Center Atlanta, we diagnose and treat failed back surgery syndrome for patients in Atlanta and those willing to travel from across the United States. Dr. Chappuis is considered a renowned specialist in diagnosing and treating failed back and neck surgery and is able to review patients thoroughly and find the correct cause of FBSS. For more information, or to get started, call today at 404-620-5523.