How to Diagnose Failed Back Surgery Syndrome

By August 26, 2019June 15th, 2020Back Pain

How to Diagnose Failed Back Surgery Syndrome - PMIR

Failed back surgery syndrome is a large collection of symptoms occurring as part of a series of potential post-operation complications, after a form of back surgery. Different types of surgery can cause different complications, and as such, failed back surgery syndrome often is used more as an umbrella term than as a concrete diagnosis or syndrome. Put plainly, it’s any series of neuropathic or mechanical spinal pain happening after and in direct relation to a recent spinal surgery.

There are several ways to diagnose this syndrome, but it first helps to detail how it occurs, what it looks like, and what surgeries in particular seem to have a higher risk for FBSS in the short or long-term.

What Is Failed Back Surgery Syndrome (FBSS)?

No surgery has 100 percent chance of success. Even the most renowned and talented surgeon can make a mistake, and even a perfect procedure doesn’t prevent something from going wrong during the recovery process.

While failed back surgery syndrome somehow seems to imply that this is something that happens especially often with back surgery and spinal surgery, this is not necessarily true.

There simply is no such thing as a failed knee surgery syndrome, a failed heart surgery syndrome, a failed brain surgery syndrome, and so on. In most cases, if someone gets surgery and continues to experience pain thereafter, it is simply pain experienced after surgery.

For all intents and purposes, this is exactly what FBSS is. This is further complicated by the fact that a surgery doesn’t require any complications whatsoever to ‘fail’. The reality of pain is that it’s very subjective, and its origin can be incredibly complex and multipoint.

It’s hard to pinpoint where pain is coming from in some cases, and while surgery can be a last-ditch effort to help resolve a patient’s extreme chronic pain, there’s only so much a surgeon can do when cutting into a patient – namely, stabilize a joint or vertebrae, and help relieve pressure from a nerve or nerve root.

It’s not guaranteed that doing so will always resolve a patient’s pain, meaning some surgeries may end with a patient continuing to experience at least some pain. Some surgeries are more likely to lead to a positive outcome than others – meaning, under certain circumstances, it’s easier to say that surgery is going to have a favorable outcome on a patient’s overall quality of life, while under other circumstances, it may not be possible to accurately predict whether surgery will lead to less pain, or no real change.

How Does FBSS Occur?

Failed back surgery syndrome can occur in surgeries that had a lower likelihood of succeeding in reducing symptoms of pain, but symptoms can also occur due to:

    • Epidural scarring – epidural fibrosis can occur after back surgery, and involves scarring after surgery, and can cause pain. It is cited as the most common cause of FBSS.
    • Problems with post-operative rehab – post-operative rehab complications include pain during physical rehabilitation.
    • Recurring herniation or stenosis – Decompressive surgery, which aims to relieve pressure from a nerve, can fail due to recurring spinal compression due to another herniation or spinal stenosis.
    • Failed fusion – Spinal fusion surgery aims to join two or more vertebrae together. This process can fail.

Not a Uniform Syndrome

One of the controversies surrounding FBSS is the use of the term itself, as it may imply malpractice, or improper recovery measures on the patient’s part, to the point that some medical professionals have deemed it judgmental and/or pejorative. Further problematic is the fact that it is not a uniform syndrome, as different surgeries can lead to very different complications.

It’s normal for a surgery to have some measure of risk attached to it, and high-risk surgeries (such as those surrounding volatile spinal conditions) may be more prone to failure. But the resulting symptoms will vary greatly depending on the original cause for the surgery, and the manner in which recovery failed.

As such, a large variety of different imaging and diagnostic tools are used to diagnose FBSS and further identify how it was caused, and how it should be treated.

How Is FBSS Diagnosed?

FBSS is diagnosed through a number of examinations and imaging tests, and a review of a patient’s medical history. The most important indicator for FBSS is prior surgery, which is why medical history is critical. A highly detailed account of pre-, peri-, and post-operative observations will help a medical professional come to a better conclusion regarding the origin and nature of their patient’s pain. Family history may also come into account.

From there, a number of different imaging tools and scans and help determine where the pain is coming from, whether the surgery took, and whether the symptoms being experienced are a result of post-operative problems, or indicate that the operation failed to address the origin of the back pain.


    • An x-ray is often the first form of diagnostic imaging used. It takes a front and back image of the body for doctors to look through.
    • A bone scan can help a doctor identify if there are any changes or fractures in the bones. This can help rule out any new injuries. This is done through an injection of a special diagnostic substance into a patient’s vein, where the substance seeks out and pools around areas in the spine with any fresh damage. A scan will then show areas where the substance pooled together the most, revealing breaks and fractures otherwise not visible on an X-ray.
    • A better look at the soft tissue around the bones of the spine can help diagnose post-operative back pain as well. This is where an MRI comes into the picture. MRIs are large tubes that use magnetic waves and radio waves to compile detailed images of the body, or a section of the body. They’re used to identify the condition of the spine’s discs.
    • A CT scan does a better job of providing a 3D image of the spine’s bones, identifying fractures, bone spurs, and spinal alignment issues. Since they don’t use magnetic waves, they’re also an alternative for people with implants and pacemakers.

Physical Examination

    • A physical exam can give doctors a lot of information about the nature of a patient’s pain as well, by examining their mobility, pain levels, strength, sensation, and nerve reflexes.

Treating Failed Back Surgery Syndrome

FBSS can be treated through a multimodal approach, typically combining psychological treatment, physical therapy, pharmacology, interventional medicine, and non-interventional alternative medicine (chiropractic, massage therapy, electrical stimulation, acupuncture, and more).

Different cases and different patients require different treatments. Some patients respond better to some treatments than others. Long-term pain management for cases of FBSS rely entirely on the cause of the symptoms, and the symptoms themselves.

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