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What is FBS (Failed Back Syndrome)?

Updated: Mar 7, 2023

Failed Back Syndrome (FBS) is a “waste bucket” diagnosis given to patients with unbearable back pain despite having had surgery. In other words, if a patient has back surgery for low back and fails to improve and no specific cause has been found, then they are called a “failed back syndrome” patient.

This can be a devastating diagnosis because the patient is left without recourse and with a sense that the “failure” is somehow his fault - that the best possible medical science was applied and “you, the patient, failed to improve.” FBS patients are forced to accept that all they can do is to live with their pain.

Even worse, having the diagnosis of FBS infers that the cause of low back pain is both unknown and unknowable. Unknowable because if a more specific diagnosis were known, then that diagnosis would be used instead. For example, if a patient has recurrent low back pain a few months after surgery and is found to have a a broken pedicle screw, then the diagnosis would be “spinal instrumentation failure,” not FBS. Consequently, a specific treatment could be offered: replacing the screw and supplementing the fusion.

I believe that the term FBS has one enormous value - identifying patients who need a better diagnosis because the result would be better care. That’s what my team and I do. We begin by working with new patients to gather all of the prior records and then initiate an exhaustive review of a patient’s history and prior medical diagnostics. Sometimes we contact prior caretakers for insights. We then apply our increasingly sophisticated diagnostic assessment algorithms to recommend steps needed to better define the causes of pain, often with new diagnostics.

Our end-point at APTEUM SPINE is not doing more diagnostic procedures or surgeries. We would rather collaborate with the patient’s existing doctors and surgeons to achieve a better understanding of what worked and what failed. Sometimes, existing test results and other clinical information is sufficient to achieve a better understanding rather quickly. Other times, more testing and conservative care is needed to grow our understanding of the patient’s pain. Almost always, when the causes of pain are clear, better treatments become evident and better results are achieved. We have been successful in treating many FBS patients this way for years and we feel strongly that there isn’t an FBS patient anywhere that can’t be improved by our careful, thorough re-evaluation process.

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