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Failed Back Surgery Syndrome

Failed Back Surgery Syndrome



Failed back surgery syndrome (FBSS) isn’t truly a “syndrome.” It’s a term that applies to patients who underwent back or spine surgery but continue to have pain afterward. In these cases, surgery is said to have failed. In the majority of cases, FBSS does not mean the surgery was “botched” or performed incorrectly — it simply means the treatment was not effective and the surgery did not achieve the desired outcomes. FBSS can occur after any type of spinal surgery.


There are many reasons back surgeries fail. Although doctors do not always know what causes a spinal procedure to be ineffective, common reasons for failure include:

  • Misdiagnosis of pain. In some cases, an orthopedic surgeon may fail to correctly diagnose the etiology of back or leg pain. Many back and spine conditions have similar symptoms, affect multiple areas of the body and cause referred pain, all of which can make an accurate diagnosis challenging.
  • A fusion nonunion. A fusion surgery doesn’t actually fuse vertebrae in the spine. A fusion procedure stabilizes the spine with hardware and creates an environment where new bone growth will cause adjacent vertebrae to fuse naturally over time. Unfortunately, there are some cases where the bones fail to fuse. This may cause continued pain and destabilization of the spine as the hardware loosens.
  • Inadequate decompression. During a decompression surgery, the primary goal is to relieve pressure on spinal nerves that are pinched by a herniated disc or spinal stenosis. If a surgeon fails to create enough space around the spinal nerves and spinal cord, it may lead to recurrent disc herniation or stenosis.
  • Multilevel degeneration or new onset degeneration. It’s possible that a surgery was successful at the spinal level where it was performed, but continued wear and tear degeneration across multiple levels is causing continual back pain and symptoms.
  • Altered biomechanics. A surgery like a spinal fusion may redistribute abnormal load burdens to adjacent spinal structures. An increased load burden can contribute to degeneration of areas around the fusion. Additionally, redistribution of load burdens and overcompensation by other areas of the spine can lead to increased tension, tightness, fatigue and spasms.
  • Scar tissue formation. After surgery, it’s normal for scar tissue to form around the surgical site as part of the healing process. In some cases, scar tissue may bind to nerve roots and cause postoperative pain. 

Although the development of FBSS is very unpredictable, some identified risk factors include obesity, presence of an emotional disorder (depression, anxiety), smoking, and surgery connected to litigation or worker’s compensation (legal issues can cause a delay in treatment).


Following surgery, some people with FBSS feel the same amount of pain as they did before their procedure. In some cases, pain is partially resolved but still present. In other cases, people feel better for weeks or months before the pain flares up again. And in some unfortunate cases, pain actually worsens in the weeks and months following surgery. 

While it’s perfectly common and normal to feel pain and tenderness after a surgery, if you continue to experience pain after several weeks of recovery and rehabilitation, you may have FBSS. Continued lower back pain, leg pain and sciatica are all common symptoms of FBSS. Other symptoms you might feel after a failed procedure are stiffness, muscle spasms and weakness.


In many cases, a second surgery is not recommended. In fact, statistics show that the rate of success decreases with each additional surgery performed. FBSS is more commonly managed with conservative treatment measures. Treatments can include:

  • Medications. Over-the-counter anti-inflammatories can provide relief for pain, swelling and inflammation. If you’re experiencing significant pain, your doctor may prescribe stronger medications or muscle relaxants.
  • Physical therapy. Physical therapy and rehabilitation is a common treatment course for FBSS. During physical therapy, you’ll work on strengthening your back and core muscles, increasing flexibility and range of motion in the spine, and improving balance and endurance.
  • Injections. A corticosteroid injection directly into the spine can reduce pain and inflammation around irritated nerve roots. While the effects of an injection are temporary, the period of pain relief will give you time to become stronger and more mobile in physical therapy.
  • Nerve ablation. If a corticosteroid injection is effective, you may be a candidate for a longer-lasting nerve ablation procedure, which destroys nerves and prevents the transmission of pain signals. 

There will be some cases where a second surgery is required. 


A surgical revision is not usually recommended. Statistics show that the chances of a successful procedure drop with each subsequent surgery performed. However, if you develop incontinence, progressive weakness, worsening pain or hardware malfunction, a second surgery may be a treatment option. 


At Integrity Spine and Orthopedics, we specialize in identifying, diagnosing and treating a wide range of acute and chronic back, spine and joint conditions. Our board-certified orthopedic surgeons specialize in performing minimally invasive spine surgeries to reduce pain and improve mobility for patients diagnosed with spinal arthritis, degenerative disc disease, bulging or herniated discs, a pinched nerve, spinal stenosis and more. 

Some of the primary benefits of minimally invasive surgery include:

  • Smaller incisions
  • Fewer complications and blood loss during surgery
  • Less damage to surrounding muscle and soft tissues
  • Lower risk of infection
  • Less post-op pain and less reliance on strong pain medications during recovery
  • Faster recovery and rehabilitation
  • Better cosmetic results with minimal scarring 

If you’re experiencing back or joint pain, weakness, or a loss of mobility, reach out to us today to schedule a consultation with our team. We provide compassionate and comprehensive care to help you find relief from pain and get back to doing the activities you love.

Call us at 904-456-0017 or contact us online to request an appointment.