The Bonati Institute Glossary: Failed Open Spine Surgery (FBSS)

The mission of The Bonati Institute is to provide hope to people suffering with chronic pain from a back or neck condition. We believe that a well-informed patient is vital to restoring hope and finding answers to pain. We developed this web site primarily to help educate pain sufferers and their families. We’ve found that the more individuals in pain learn about their anatomy, their condition and the options available to them the more likely they will be to choose the advanced arthroscopic procedures offered by The Bonati Institute.

Failed Open Spine Surgery (FBSS)

Following open spine surgery, whether it is a fusion, discectomy or laminectomy patients can experience chronic pain in the back and or the arms or legs. These syndromes are often due to identifiable causes but are termed by surgeons and the medical community to be failed back surgery syndrome (FBSS). Nearly all open back surgeries include one form of fusion. The true test of whether an open back surgery is successful is not to measure the success of the fusion process but the actual reduction of pain. For single level fusions, the percentage obtaining significant pain relief is 40-80% while with three levels, this drops to approximately 15%.

Some of the most common causes of failed open back surgery are:

Residual foraminal stenosis due to inadequate exploration of the nerve root during open.

Residual spinal stenosis due to failure to appreciate the spinal anatomy during surgery.

Painful disc disease due to residual pain emanating from the discs which still retain motion.

Spinal instability due to removal of too much of the central disc or removal of too many supporting ligaments.

Treatment Options

The Bonati Arthroscopic Laser Discectomy

The procedure is designed as an answer to stenosis, herniated discs, disc disease and spinal instability from previously failed open surgeries.

In this procedure the portion of the disc that is causing nerve compression can effectively be removed through a small incision. With the patient awake, a needle is placed into the area of the disc that is producing symptoms. A small incision is made on the patient’s back and the endoscopic tube is inserted.

Using specially adapted endoscopic instruments the diseased disc material is removed and then a laser vaporizes the surrounding problem tissue. A laser is then used to shrink and remodel the remaining disc. A small dressing is used to cover the incision.

Often patients feel immediate relief following this procedure. Rehabilitation begins within hours of surgery, and involves gait training, back or neck support, and walking. Post-operative pain management program avoids narcotics in favor of a Transcutaneous Nerve Stimulator that blocks pain messages to the brain.

The benefits of this procedure:

• Fewer risks, local anesthesia, a small incision
• Minimal blood loss
• Short recuperation time
• Minimal damage to tissues
• Surgeries are done in an outpatient setting
• Patient sees a faster return to a normal lifestyle

The Bonati Arthroscopic Laser Foramenoplasty

A foramen is the window through which a nerve root exits the spine. Bone spurs that form as a result of Degenerative Disc Disease or spinal arthritis may narrow the foramen causing spinal stenosis or foraminal stenosis, conditions that typically cause severe pain. Also, a foramen may be narrowed by a herniated disc or scar tissue from previous surgery. These problems are treated by foramenoplasty.

Foramenoplasty is performed through a small incision in the back, while the patient is conscious under a low-level IV sedation. The narrowed foramen is located with fluoroscopic x-rays, and a guide wire is placed down to the area of disease. Then, a hollow tube is inserted over the wire to the foramen.

The endoscope and surgical instruments are inserted through the tube. The miniaturized television camera on the endoscope provides direct visualization of scar tissue, bone spurs, and diseased disc material. After surgery the patient is prescribed a short course of physical rehabilitation

The benefits of this procedure:

• Fewer risks, local anesthesia, a small incision
• Minimal blood loss
• Short recuperation time
• Minimal damage to tissues
• Surgeries are done in an outpatient setting
• Patient sees a faster return to a normal lifestyle