Back pain is one of the most common health complaints among adults, with millions of individuals seeking relief through physical therapy, injections, medications, and, in some cases, spinal surgery. But what happens when surgery doesn’t fix the problem—or even makes things worse? For many, this scenario leads to a frustrating condition known as Failed Back Surgery Syndrome (FBSS).
At Pain Management and Injury Relief (PMIR), we see firsthand the emotional and physical toll of FBSS—and more importantly, we help patients find solutions. This article will explore what FBSS is, why it occurs, how it’s diagnosed, and the many ways it can be manage. d or treated.
What Is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome isn’t a specific disease, but rather a general term used to describe persistent or worsening pain after spinal surgery. Despite its name, the syndrome doesn’t necessarily mean the surgery failed technically—it means the outcome didn’t meet the patient’s goals, especially in terms of pain relief and function.
In fact, it’s estimated that up to 20–40% of people who undergo back surgery experience FBSS. This doesn’t always reflect poor surgical skill, but rather the complexity of spinal anatomy and pain pathways.
Common symptoms of FBSS include:
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Chronic lower back pain
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Sciatic leg pain or burning
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Pain that returns months or years after surgery
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Numbness or weakness in the legs
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Limited mobility and stiffness
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Depression, anxiety, and frustration due to chronic pain
Why Back Surgery Doesn’t Always Work
Spine surgery is often viewed as a last resort when conservative treatments fail. However, it’s important to understand that not all pain can be “cut out”. Here are key reasons why some back surgeries don’t produce the desired outcomes:
1. Incorrect Diagnosis
One of the most common reasons for FBSS is misidentifying the source of the pain. For example, a patient may undergo lumbar discectomy to remove a herniated disc, only to discover later that the primary cause of pain was actually facet joint arthritis or sacroiliac joint dysfunction.
2. Scar Tissue Formation
After surgery, the body forms scar tissue (epidural fibrosis) around the nerves and surgical site. This can compress nerves and create new pain, especially if it impedes nerve signal transmission.
3. Adjacent Segment Degeneration
Sometimes the spinal segments above or below the surgery site begin to break down due to the altered biomechanics of the spine. This can lead to new pain, instability, or herniation.
4. Nerve Damage or Sensitization
Nerves that were already irritated before surgery may become more sensitive afterward. In some cases, neuropathic pain develops, leading to burning or shooting sensations.
5. Infection or Hardware Issues
Though rare, post-surgical infections or problems with surgical hardware (e.g., screws, rods) can contribute to poor outcomes and pain.
Who Is at Risk for FBSS?
Anyone undergoing back surgery can develop FBSS, but certain risk factors increase the likelihood, including:
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Multiple spinal surgeries (revision surgeries increase complexity)
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Preexisting conditions such as diabetes or depression
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High levels of pain pre-surgery
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Smoking (which impairs healing)
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Inadequate physical rehab post-surgery
How FBSS Is Diagnosed
Diagnosing Failed Back Surgery Syndrome requires a thorough evaluation. The goal is not just to label the condition, but to identify why pain persists and what can be done about it.
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Detailed medical history review
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Imaging studies: MRI, CT scans, or X-rays
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Electrodiagnostic tests: EMG or nerve conduction studies
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Physical and neurological exams
This comprehensive assessment helps determine whether pain is from nerve root compression, hardware issues, instability, inflammation, or something else entirely.
Treatments for Failed Back Surgery Syndrome
While FBSS can be frustrating, it’s far from hopeless. In fact, many patients experience meaningful improvement through interventional pain management, minimally invasive procedures, and lifestyle changes.
1. Spinal Cord Stimulation (SCS)
This innovative treatment involves implanting a device that sends electrical pulses to the spinal cord, disrupting pain signals before they reach the brain. It’s often used when nerve pain doesn’t respond to medications or injections.
2. Nerve Blocks and Injections
Injections such as epidural steroid injections, facet joint blocks, or nerve root blocks can help reduce inflammation and diagnose specific sources of pain.
3. Radiofrequency Ablation (RFA)
RFA uses heat to disable specific pain nerves, offering relief that can last 6–12 months. It’s particularly effective for facet joint pain or recurring low back pain.
4. Medication Management
Medications are not a long-term solution on their own, but targeted use of anti-inflammatories, muscle relaxants, or nerve agents like gabapentin can help during flare-ups.
5. Ketamine Infusion Therapy
In cases of severe, treatment-resistant pain (especially with a neuropathic component), low-dose ketamine infusions can reset nerve signaling and reduce central sensitization.
6. Physical Therapy & Lifestyle Modifications
Rehabilitation is essential—even after a “failed” surgery. Movement, posture correction, and core strengthening help reduce strain on the spine.
Our team often combines physical therapy with behavioral support to help patients regain confidence and activity levels.
Living with FBSS: Tips for Daily Life
Living with FBSS is about managing pain, not surrendering to it. Here are several coping strategies to enhance quality of life:
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Practice pacing: Avoid overexertion or prolonged inactivity
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Sleep support: Optimize mattress and posture
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Stress management: Chronic pain and anxiety are deeply linked
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Track symptoms: Note when pain increases or improves
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Stay connected: Isolation worsens outcomes—seek support groups, friends, or counseling
Should You Consider Another Surgery?
This is a complex question. In general, repeat spinal surgeries have lower success rates—especially if the cause of pain isn’t mechanical. However, if clear structural issues exist (e.g., spinal instability, infection, hardware failure), surgery may be appropriate.
Before considering another operation, seek a second opinion, like the team approach offered at PMIR.
FBSS: A Treatable Condition, Not a Dead End
Failed Back Surgery Syndrome doesn’t mean you’ve run out of options—it means you need a more personalized, layered approach to pain. Interventional pain medicine offers many ways to treat pain at its source, often without the need for further surgery.
At Pain Management & Injury Relief, our specialists are experts in managing chronic spine pain through innovative, minimally invasive techniques. Whether you’ve had one surgery or multiple, we’ll work to help you understand your pain, regain control, and restore quality of life.
Take the First Step Towards Pain-Free Living Today
