What Causes Back Surgery To Fail ? - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 5 фев 2025
- Dr. Ebraheim’s educational animated video describes conditions that may cause back surgery to fail?
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What is the definition of failed back surgery syndrome?
The definition is persistent, new appearing, recurrent low back pain or lower extremity pain following one or more spine surgeries that was thought to be likely to relieve the pain of the lower back. The outcome of spine surgery does not meet the expectations of the patient and the surgeon.
Common causes of failed lower back surgery are:
• Operation on the wrong patient
• Incorrect diagnosis
• Incorrect procedure
• Poor technique
• The problem came back or may be progressive
• We failed to match the patient’s goals with our ability to achieve these goals, so we get an unexpected outcome, and the patient is dissatisfied.
Back surgery is better for leg pain than for low back pain. In absolute indications for surgery are cauda equina syndrome that causes bladder and bowel disturbance or progressive neurological deficit. The usual indication for surgery is that the patient’s symptoms are not resolved with nonoperative treatment. 80% will rely on the history, 15% will rely on the physical exam and 5% will rely on the studies for diagnosis. Patient with failed back surgery syndrome means that there is no improvement. Causes that can lead to failed back surgery syndrome:
• Poor patient selection (the most common cause of failed back surgery syndrome
The patient has problems that we did not address before surgery
The patient may have intrinsic psychological disturbance, they have elevation of hysteria, hypochondriasis, depression and anxiety, and abnormal pain behavior.
To predict the outcome, the patient will need evaluation incorporating a comprehensive variety of medical and psychological risk factors, which can be predictive of spine surgery outcome in about 82% of the patients.
• We made the wrong diagnosis
Either the diagnosis is incorrect or incomplete
May be relied on the MRI and the x-rays that incorrectly shows degenerative changes which is age related and asymptomatic in a lot of patients
The physician must correlate the patient’s symptoms with physical examination and imaging. When they are not aligned, the chance of failure is increased.
Failure to diagnose a painful transitional segment above or below an area to be fused may cause the pain to continue after surgery.
Failure to diagnose a far lateral herniated disc may result in failure to relieve the leg pain.
Failure to address foraminal or lateral stenosis in a patient with central stenosis may result in continued radicular pain
• The doctors chose the wrong procedure
Operating on the wrong level is the most common error and intraoperative radiographic localization in all cases is important.
The doctor may have gone posteriorly instead of anteriorly and vice versa, or the doctor did decompression of one site when the patient has multiple painful sites.
Doctors are missing other pathology that they did not address.
• Poor Technique
You selected the patient properly, diagnosed the case very well, you chose the proper surgical procedure, but a poor technique was done.
Incomplete decompression was done, the doctor left the residual deformity, or the doctor caused iatrogenic instability or battered root syndrome.
• Progressive Disease or Recurrent Pathology
Recurrent disc herniation, recurrent spinal stenosis, or transition syndrome.
Recurrent disc herniation occurs in about 5-15% of the time. Half of them occur in a new level or on the other side
Stability of the fused segment will increase the load on the adjacent segment and accelerate disc degeneration (transition syndrome). This syndrome occurs in lumbar spine surgery patients up to 30% within 10 years. Patients will have x-ray evidence of segment deterioration. A similar process occurs with time that is at the SI joint and occurs after lumbar fusion with the degeneration extending to the SI joint. Incidence is about 40%.
• Failure to Achieve the Goals of Surgery
The decompression was inadequate or incomplete and the correction of the deformity was inadequate or incomplete, or the patient may have a nonunion.
Our procedure failed to achieve these goals so there is an unexpected, adverse or unfavorable outcome and the patients usually do not like that.
• There may be a new source of pain that may not be related to the initial surgery
Consider the potential source of symptoms, then this can help in directing the appropriate diagnostic study and the appropriate treatment. Look for occult chronic infection. Look for occult nonunion, persistent stenosis, or alignment that is not corrected. Look for other anatomic sites that cause similar problems such as the hip and SI joint. Assess the vascular disease, the hip and assess the patient for peripheral neuropathy. Assess findings of pain behavior like Waddell Signs.
At sixty four years old and post 24 months fusion, I feel I'm back in school with Dr. Ebraheim's. This man is so helpful in trying to understand how to get to the bottom of continued chronic low back pain and emoting that pain location and symptoms to a surgeon. Very helpful. Thank You.
"We operated on the wrong patient"...was not expecting that one. Imagine needing brain surgery but instead having your spine fused.
Thats not what that means. People are complex individuals with comorbid conditions or personality factors. See 4:27
@@notofthisworld5998 was a joke. lighten up. :(
😂😂😂
Thanks Dr Nabil, it was very good information for both doctors and patients
Thanks
"We operated on the wrong patient".... wtf. How in the living hell is that even possible nowadays?
Dr. Ebrahim, thank you for this video. This is very helpful. I've encountered failed back syndrome in clinic as a resident. Can you make a video explaining the techniques/tips on how to prevent failed back syndrome? For example, the transition syndrome, incomplete decompression/correction of deformity. Thank you!
Thanks proffesor
👍👍👍❤❤❤❤👍❤ thank you for sharing.👍❤
Very Competent Report
My surgery failed... I can walk less now. surgeon will not discuss it.. doctor are monsters now
All doctors??
My mom had severe sciatica on her right side, but it got worse after her surgery that was meant to alleviate it. She is now handicapped and cannot walk more than a few feet. What could cause this so I may better articulate it to the surgeon to help her. Thank you.
Somewhat disagree, I had an L5, S1 fusion in 2004 I went in on Monday morning, home Tuesday morning, and back to work the next Monday 7 days after fusion. Everything was fine for about 5 months, when scar tissue started growing into S1. When I talked with the surgeon and a pain management doctor both said the same thing. Scar tissue is a problem with any surgery, and having another will only bring more scar tissue. In most cases, the only one that the surgery helps is the doctor's bank account. I know a 51 year old that has had 3 back surgeries, each making thing worse. Now the doctor wants to put a stimulater inplant in, which will make 4. Why wasn't it done sooner?
What's the difference between athletes Dr's & our Dr's so CUD this go on for life?
Dr Nabil you are the best❤
It's true
د. نبيل إبراهيم من أي دولة ؟
وهل لديه عيادة خاصة لعلاج آلام الظهر ؟
أتمنى ترجمة الفيديوهات للغة العربية لأني لا أتقن اللغة الانجليزية .
شكرا لكم
مصري يعيش بولاية أوهايو في أمريكا، يعمل في جامعة توليدو Toledo
I’ve had l5-s1 surgery and c6-c7 surgery along with hip labrum tear repair and shoulder on same side. Hip hurt got it done, then back, did it then month later did neck. My back is killing and around hip seems like on fire and pressure on legs I need to sit down or put em up. Neck hurts too.. working is whole reason for all but it’s bad again and agony and draining. Energy destroyer , and straining on mood and crappy sleep , stc
🌹
Never trust surgery
I have the diagnosis of failed back surgery but I don't consider it that way. It helped me immensely and I am still able to walk.
I can't get another opinion with my insurance so I'm confused on what to do
I had lumbar 4 5 now few years later the other side hurts I am confuse really don't know what to do next.
I am Tamil Nadu
You have conveniently left out the biggest culprit. “ EPIDURAL FIBROSIS” also known as SCAR TISSUE.
I had back surgery through my stomach and I'm worse than ever! I had one spinal stimulator trial and it didn't work now they want to do another one I guess it's different I don't know what to do I don't want another spinal stimulator trial the first didn't work y will this one
Find a new neurologist surgeon!!!
QUESTION: I have pain in my both legs after surgry of L4, L5, S1. Now I can see 4 screws in L4 and L5. But after 3 weeks I feeling SHOCK in right foot below ankel. That was same as before operation but I do not know is this normal or temporary shocks or fail surgery.
Norma
@@dhukkiif that is normal, what is the point for such a huge operation?
@@JCMasterCraftsmanback surgery is highly variable and many doctors won't tell you that it won't work because it's bad for business.
Thanks my doctor Rammutla Sunward park Boksburg Gauteng South Africa did not treat me right I have this bulge and he told me he cannot do anything about it but he put the screws in and took them out and said sorry bye bye cannot do nothing so upset please try and help me
لماذا لاتوجد الترجمه الى اللغه العربيه؟
اتمنى لو تضيف اللغه العربيه للفيديو
متابعه من بغداد
Please explain in Tamil
I think my surgeon choose use MRI instead my symptoms 😭, I still have my right foot without it's movement.
MRI shows left side worse but the reality is it was the right side damaged instead.
🙋🙋
I not understand your language sir