Failed back surgery syndrome is pain that lasts or comes back after spine surgery. The name is unkind, and the problem is common.
What is failed back surgery syndrome?
The surgery may have gone exactly as planned, and the pain still lasts. That is because the part that was operated on was not the only pain source, or because a new source has shown up.
Common causes: adjacent segment degeneration (the level next to the surgery breaking down), epidural scarring, sacroiliac joint overload after fusion, and central sensitization. That last one means the nervous system turns up its pain volume after years of untreated pain.
What are the symptoms of failed back surgery syndrome?
- Pain that never fully went away after surgery.
- Pain that went away and came back months or years later.
- New pain in a different place.
- Leg symptoms in a different area from before.
How do you fix failed back surgery syndrome?
- A fresh diagnosis, not an assumption that the surgery failed.
- Sacroiliac joint assessment. It is often the real source after lumbar fusion.
- Epidural injection and adhesiolysis (freeing scar tissue) where scarring is the issue.
- Neuromodulation assessment in some cases. Neuromodulation uses mild electrical signals to change how nerves send pain.
To be assessed, call us or request an appointment.
What usually gets missed
The name is misleading, and the idea behind it is usually wrong. Most of these patients did not have failed surgery. They had successful surgery on a part that was not the only source of their pain.
The sacroiliac joint is the single most commonly missed contributor after lumbar fusion. Next come adjacent segment degeneration and epidural fibrosis (scar tissue around the nerves). All three can be found. None of them means the first operation was done badly.
What to expect over time
A fresh diagnostic workup after failed spine surgery finds a clear pain source in a large share of cases. Blaming the surgery shuts that door.
When a physical source is confirmed, targeted treatment works as well here as anywhere. When it is not, spinal cord stimulation has its strongest evidence base in exactly this group of patients. The trial is fully reversible before anything is implanted.
When this becomes urgent
Fever, wound discharge or growing pain in the weeks after surgery suggests infection and needs same-day review. A new neurological deficit (new weakness or numbness) after a stable period, or any bladder or bowel change, is an emergency no matter how long ago the surgery was.
What causes failed back surgery syndrome?
The label describes lasting pain after spine surgery. It is not a single condition. It is unhelpful because it names a result instead of a cause. The useful work is finding which of several different causes applies: scar tissue tying down a nerve root, a disc that herniates again, a segment adjacent to a fusion taking up the motion, sacroiliac pain that was never the target of surgery, or a nerve injury that was already there before the operation.
What it gets confused with
Each of those has a different treatment. That is why the first job is a fresh diagnosis, not an assumption that nothing more can be done. Patients arrive believing the surgery failed and the case is closed. Often the operation did exactly what it aimed to do, and something else is now causing the pain.
Why the diagnosis comes before the treatment
Treatment aimed at the wrong part gives a poor result and teaches you nothing. Many patients are already there by the time they arrive. Confirming the source costs one appointment and changes the odds a great deal. When we cannot find it with confidence, we say so instead of going ahead on a guess.
Common questions
Does this mean my surgery was done badly?
Usually not. Far more often it means the pain had more than one source, and only one was operated on.
How this happens is covered in After Spinal Fusion: What to Avoid.
Is there anything left to try?
Often yes, once the current source is found. Options depend on the mechanism and include lysis of adhesions, targeted blocks and stimulation.
Is failed back surgery syndrome permanent?
Not by default. A fresh diagnostic workup after spine surgery finds a clear pain source in a large share of cases. Examples are the sacroiliac joint, a segment next to a fusion, or scarring around a nerve root. Once the source is confirmed, targeted treatment works as well here as anywhere. When no single source is found, spinal cord stimulation can be trialed, and the trial is fully reversible.
How common is failed back surgery syndrome?
Pain that lasts or comes back after spine surgery is common. The name is unkind and misleading. Most of these patients did not have failed surgery. They had successful surgery on a part that was not the only source of their pain. The sacroiliac joint is the contributor most often missed after a lumbar fusion.
When is pain after back surgery an emergency?
Fever, wound drainage or rising pain in the weeks after surgery can mean infection and needs same-day review. New weakness, numbness or other nerve changes after a stable period, or any change in bladder or bowel control, is an emergency no matter how long ago the surgery was. Go to an emergency department instead of waiting for a clinic visit.
Sources
- van de Minkelis J et al. 6. Persistent spinal pain syndrome type 2. Pain practice : the official journal of World Institute of Pain, 2024. PubMed 38616347
- Baber Z et al. Failed back surgery syndrome: current perspectives. Journal of pain research, 2016. PubMed 27853391
- Chen YC et al. Narcotic Addiction in Failed Back Surgery Syndrome. Cell transplantation, 2019. PubMed 30168351
Hurt in an accident? Start here.
You do not need a lawyer, a police report or a referral to be seen. Bring your symptoms and we will work out the rest.
Monday–Friday, 8:00 a.m. – 4:00 p.m. Same-day appointments are often available for new accident and injury patients.