Failed Back Surgery Syndrome: Definition, Causes, Symptoms, Diagnosis, Treatment

Back Pain Treatments

Failed back surgery syndrome (FBSS) is a term used to describe persistent pain and discomfort following surgery on the spine. FBSS can occur after any type of surgery on the spine, including laminectomy, discectomy, and spinal fusion. The condition is characterized by ongoing pain, numbness, or weakness in the back or leg that does not improve after surgery. The pain may be the same as or worse than it was before the surgery. FBSS is not a specific diagnosis, but rather a collection of symptoms that can have many different causes. Possible causes include: scar tissue that forms around the surgical incision, nerve damage, and problems with hardware from the original surgery. Treatment for FBSS may include spine medications, physical therapy, and additional surgery.

What is Failed Back Surgery Syndrome (FBSS)?

Failed back surgery syndrome (FBSS) is a term used to describe a condition where an individual continues to experience pain or discomfort after undergoing surgery to treat pain in the back or spine. The pain may be similar to the original pain that prompted the surgery, or it may be different.

Causes of Failed Back Surgery Syndrome

There are many potential causes of failed back surgery syndrome (FBSS). Some common causes include:

  1. Inaccurate diagnosis: If the original diagnosis was incorrect, the surgery may not have addressed the root cause of the pain and thus may not have been successful.
  2. Complex or difficult anatomy: Some individuals may have complex anatomy that makes surgery more challenging, which can increase the risk of FBSS.
  3. Scar tissue: Scar tissue from the surgery can sometimes cause pain or discomfort.
  4. Hardware failure: If hardware, such as screws or rods, used during the surgery fail or loosen, it can lead to FBSS.
  5. Failed fusion: In some cases, surgery to fuse two or more vertebrae together (spinal fusion) may fail, resulting in FBSS.
  6. Persistent nerve compression: If a nerve is still being compressed after surgery, it can cause persistent pain.
  7. Other underlying conditions: In some cases, FBSS may be caused by other underlying conditions, such as degenerative disc disease or spinal stenosis.

Incidence of FBSS

The incidence of failed back surgery syndrome (FBSS) is difficult to determine accurately, as it is not a specific diagnosis and can be caused by a variety of factors. However, some studies estimate that FBSS may occur in up to 40% of individuals who have had surgery for back or spine pain.

Symptoms of Failed Back Surgery Syndrome

The symptoms of failed back surgery syndrome (FBSS) can vary depending on the individual and the underlying cause of the pain. Some common symptoms of FBSS include:

  1. Persistent pain: The pain may be similar to the original pain that prompted the surgery, or it may be different. The pain may be constant or intermittent and may be mild to severe.
  2. Numbness or tingling: These symptoms can affect the back or legs and may be caused by nerve compression or irritation.
  3. Weakness: If nerve compression or irritation is severe, it may cause weakness in the legs
  4. Difficulty standing or walking: Pain or weakness in the legs can make it difficult to stand or walk.
  5. Difficulty with daily activities: The pain or discomfort associated with FBSS may make it difficult to perform everyday tasks, such as sitting, bending, or lifting.
  6. Depression or anxiety: Chronic pain can take a toll on an individual’s mental health, and people with FBSS may experience depression or anxiety as a result.

Diagnosing Failed Back Surgery Syndrome

Failed back surgery syndrome (FBSS) is typically diagnosed through a combination of a physical examination and imaging tests.

History and Physical Examination

During the physical examination, a healthcare professional will assess your pain levels and look for any signs of weakness or changes in sensation. They may also test your range of motion and reflexes to help determine the cause of your pain.

Imaging Studies

Imaging tests, such as X-rays, CT scans, and MRIs, can help provide a detailed view of the spine and any abnormalities or abnormalities that may be causing the pain. These tests can also help identify any scar tissue or hardware failure that may be contributing to FBSS.

  1. X-rays: X-rays are a type of radiation that can pass through the body, producing an image of the bones on film. X-rays can help the healthcare provider identify any problems with the bones in the spine as well as hardware malfunctions. 
  2. CT (computed tomography) scan: A CT scan uses X-rays and a computer to produce detailed cross-sectional images of the body. CT scans can help the healthcare provider identify problems with the bones and certain soft tissues in the spine
  3. MRI (magnetic resonance imaging): MRI uses a powerful magnet and radio waves to produce detailed images of the soft tissues in the body, including the muscles, tendons, and ligaments. MRI can help the healthcare provider identify problems with the soft tissues in the spine, such as scar tissue.

In some cases, a healthcare professional may also recommend a nerve conduction study or electromyography to test the function of the nerves and muscles.

Treatment of Failed Back Surgery Syndrome

The treatment for failed back surgery syndrome (FBSS) will depend on the individual and the underlying cause of the pain. Some common treatment options for FBSS may include:

  1. Medications: Over-the-counter or prescription pain medications, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be used to help manage pain. In some cases, stronger pain medications may be prescribed..
  2. Physical therapy: Physical therapy can help strengthen the muscles and improve flexibility, which may help reduce pain.
  3. Injections: A healthcare professional may recommend injections of steroids or other medications to help reduce inflammation and manage pain.
  4. Additional surgery: In some cases, additional surgery may be necessary to address the underlying cause of the pain. This could include revision surgery to remove scar tissue or hardware that is causing pain, or to correct a failed fusion.
  5. Alternative treatments: Some individuals may find relief from FBSS through alternative treatments such as acupuncture, chiropractic care, or massage therapy.

It’s important to work with a healthcare professional to determine the most appropriate treatment plan for your specific situation.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for