Failed Back Surgery Syndrome (FBSS)

Doctor examining patient for failed back surgery syndrome

Epidemiology: How Common Is FBSS?

FBSS affects 10% to 40% of people who have spine surgery for problems such as herniated discs or spinal stenosis.
In the United States, approximately 600,000 spinal surgeries are performed annually, and over 80,000 patients develop FBSS each year.
Worldwide, the rate of FBSS after lumbar spine surgery is between 9.4% and 20%.
FBSS leads not only to pain but also numbness, tingling, and loss of function, significantly affecting daily and work life.

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Why Does FBSS Happen?

FBSS can result from many factors that occur before, during, or after surgery. Failed Back Surgery Syndrome (FBSS) is a chronic and disabling condition where pain continues after spine surgery, affecting physical function, emotional well-being, and overall quality of life. Understanding why FBSS happens helps patients and families prepare, seek the right care, and work with medical teams to minimize risks.

Failed Back Surgery Syndrome (FBSS) Surgery info

Before Surgery

Incorrect diagnosis: If the original pain wasn’t coming from the area operated on, surgery may not help.
Poor candidate selection: Not every back pain patient benefits from surgery; the right match is crucial.
Chronic health issues: Depression, anxiety, obesity, smoking, and other chronic health problems raise the risk.
Multiple prior surgeries increase the risk of poor outcomes.

During Surgery

Technical errors: Too little or too much spinal decompression, or operating at the wrong spinal level can leave issues unresolved or cause instability.
Incomplete removal of damaged tissue: Leaving part of a herniated disc or bone spurs can lead to ongoing symptoms.
Nerve damage: Working close to nerves can cause injury and lasting pain or numbness.

Woman experiencing chronic back and shoulder pain – concept of spinal cord stimulation

After Surgery

Scar tissue: Called epidural fibrosis, this can develop around nerves and cause pain.
Spinal infection: Any infection can slow healing and add complications.
Spinal imbalance or instability: Too much bone removed or failed fusion leads to abnormal movement and pain.
Recurrence or new problems: New disc herniation, adjacent segment degeneration (when new stress damages spinal areas next to the surgery) frequently cause FBSS.
Hardware failure: Screws or rods don’t fuse correctly or move, resulting in persistent symptoms.
Incomplete healing or not following rehab: Poor post-surgical care, skipping physical therapy, or exceeding activity limits can worsen pain.

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Other Contributing Factors

Psychological health is a major risk: depression, anxiety, and pain sensitivity magnify suffering and make recovery harder.

Complications like blood clots, and adverse reactions to anesthesia or medications, though less common, can also contribute..

Diagnosis

Diagnosis involves a combination of detailed history-taking, physical and neurological exams, and imaging studies—typically X-rays, CT scans, or MRIs—to localize sources of pain and identify any structural problems, nerve damage, or scar tissue. A multidisciplinary team often helps clarify complex symptoms and coordinates the plan for care.

Treatment Options

FBSS requires individualized, often multi-step treatment:
Medications (for pain, nerves, depression/anxiety).
Physical therapy (exercise, strength, learning new movement patterns).
Interventional procedures (steroid injections, nerve blocks, spinal cord stimulation).
Psychological support (counseling, coping training).
Revision surgery (correction of nerve compression, hardware failure, or instability—done only after careful consideration).

Find out if you are a candidate

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_References

^{Northwestern Medicine: FBSS Overview and Incidence}
^{Yeungnam University Journal of Medicine: FBSS Epidemiology}
^{PMC: FBSS Prevalence and Burden}
^{Pain and Spine Specialists: FBSS Therapies}
^{SE Pain & Spine Care: Diagnosing & Treatment Options}
^{Ascent Pain Solutions: Signs, Diagnosis, and Treatments}
^{Spine Center Atlanta: Signs and Realities of FBSS}
^{Gavin Publishers: FBSS Symptoms}
^{Failed Back Surgery Statistics: US Figures}
^{Cedars-Sinai: FBSS Daily Living Impact}
^{NYU Langone Health: Diagnosis of FBSS}
^{PMC: FBSS Review and Imaging}
^{Spine Center Atlanta: Surgical Guide for FBSS}
^{ScienceDirect: FBSS Clinical Incidence}
^{The PainSmith Clinic: Causes and Risk Factors}
^{Spine-Health: FBSS What It Is and Causes}
^{Spine Consultants: Risk Factors Before, During, After Surgery}
^{Atlantic Spine: Risks, Causes, and Treatments}
^{Texas Pain Experts: Diagnosis and Risk Factors}
^{ScienceDirect: FBSS Risk Factors Analysis}
^{PubMed: FBSS Risk Factors Study}

_{Failed Back Surgery–What You Should Know}

_{Video:https://youtu.be/dNjPVz1fLbQ?si=2HdbLy9TrVkIDb9D}