Pain in the lower back and legs can be caused by almost any structure in the back and many other organ systems. Patients with severe back and leg pains may have little abnormal findings on MRI scan and patients with no pain may have severe abnormalities, therefore it can be difficult to determine the exact causes of the pain. A good history and physical examination, radiological tests and nerve studies can identify most causes. The best outcome is when the person has typical symptoms (complaints), physical exam findings and MRI abnormalities. The less typical the complaints, the less likely the patient will benefit from surgery. If the exact cause cannot be identified or there are many possible causes, then pain mapping may be beneficial pinpoint the cause of the pain.
Pain mapping is the usage of spinal injections to delivery numbing or provocative solutions to suspected causes of the pain. Numbing medicine may block the pain and provocative medicine may worsen the pain.
The results of surgery are also affected by motivation, coping skills, psychological problems, drug addiction, lawsuits and worker’s compensation.
Failed Back Syndrome is when patients fail to improve or worsen after spine surgery. These patients often continue to take pain medicine and are unable to return to work. Failed back syndrome is not one specific problem but a generalized term for people who did not do well.
There are many causes for failed back syndrome including unrealistic expectations (they wanted to feel like they were twenty), incorrect diagnosis and treatment, correct diagnosis but wrong surgery or the problem was not properly fixed. There may be additional pain from a partially or unrecognized source. Bleeding, nerve damage or spinal leak may complicate surgery. A new problem may form after surgery, such as disc herniation, blood clot, infection or scar tissue. Muscle damage or bone removal may lead to spinal weakness, instability and new pain. The prospect of loss of income, personal attention or returning to a poor work situation may hamper recovery.
The potential for failed back syndrome can be limited if both doctor and patient are positive and have good communication and honesty. Thorough studies and an accurate diagnosis of the problem are essential as well. The attitude and expectations of the patient as well as his or her life situation must be considered by the treating physician as well for the optimum outcome.