Failed back syndrome refers to persistent leg and/or low back pain after a surgical procedure. The pathophysiology of this syndrome is complex, as often the operation was technically successful.
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Terminology
Other names for failed back syndrome include failed back surgery syndrome, post-laminectomy syndrome, or post-surgical spine syndrome.
Pathology
Aetiology
recurrent or residual lumbar disc disease
epidural fibrosis or scar
postoperative instability (at operative level or at non-operative level)
instrumentation-related, e.g. nerve root irritation from pedicle screw
wrong-level surgery
lateral recess or central canal stenosis
infection
Practical points
Contrast enhanced MRI is the modality of choice to evaluate this syndrome.
A commonly encountered diagnostic dilemma is the differentiation of postoperative scar from recurrent disc herniation, especially as it influences operative management. Both have low signal intensity on T1 weighted MR imaging, but the
Scar: irregular borders, thecal retraction towards the soft tissue mass. Early post contrast enhancement with long-term retention.
Disc: smooth borders. No or delayed post contrast enhancement. 4, 5
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