Failed back surgery syndrome (FBSS)

Failed Back Surgery Syndrome

Failed back surgery syndrome surgery — is more surgery recommended after a failed surgery?

It is estimated that up to 40 percent of patients who undergo traditional open back surgery experience failed back surgery syndrome. Surgery is a big step for any patient, and the possibility that a surgical procedure could fail to address a medical issue can be especially daunting. The incidence of failed back surgery syndrome, or FBSS, depends upon many factors. For instance, FBSS tends to occur more frequently in the lumbar (lower back) region than in the cervical (neck) region of the spine. Additionally, a patient’s risk of developing FBSS is much higher following an open spinal fusion procedure than after undergoing a minimally invasive technique.

Based on the studies published to date by the U.S. National Institutes of Health, the only scientifically defendable statement that can be made about the incidence of failed back surgery syndrome is that its likelihood increases with the invasiveness of the spinal surgery that was performed. Currently, the least invasive form of spine surgery is minimally invasive spine surgery, such as the procedures performed at Laser Spine Institute, to treat degenerative spine conditions.

What is FBSS?

FBSS is not a syndrome. Rather, it is a generalized term that is used to describe the condition of patients who have experienced unsuccessful results following spine surgery to treat neck or back pain. Specifically, the term applies when spine surgery has not alleviated the original problem or has created other, more significant problems, resulting in continuing or worsening pain.


Patients with FBSS may experience or develop symptoms in varying degrees of severity, such as:

  • Continued or chronic pain
  • New spine conditions
  • Pain above or below the treated level of the spine
  • Limited mobility
  • Inability to recuperate
  • Dull, aching pain in the neck, back or legs
  • Sharp or stabbing pain in the extremities
  • Spinal joint immobility
  • Spasms
  • Anxiety
  • Depression
  • Dependence on prescription drugs

Primary causes

Many factors can contribute to FBSS, including:

  • Failure to properly identify the condition(s) — Surgeons who see a low volume of patients with degenerative spine conditions tend to be less experienced and specialized in diagnosing and treating these conditions. As a result, when determining the underlying cause of a patient’s neck or back discomfort, a relatively inexperienced surgeon might attempt to correlate a patient’s pain pattern with an anatomical abnormality in the spine. However, the process of making an accurate diagnosis is not always this straightforward, particularly when nerve root compression in the spine leads to symptoms in distant areas of the body. Additionally, other sources of pain, such as hip osteoarthritis, can produce symptoms that are very similar to, and therefore often incorrectly attributed to, degenerative spine conditions. Based on an improper diagnosis, a surgeon might perform surgery at the wrong level of the spine or otherwise improperly treat the condition, leading to FBSS.
  • Failure to adequately decompress a nerve root or otherwise treat the condition(s) — A technical error on the part of a treating surgeon, such as leaving behind a bone fragment or some herniated disc material that is pressing on a nerve root, can result in pain that continues or worsens after surgery.
  • Spinal fusion failure — The goal of a spinal fusion procedure is to relieve neural compression by removing a damaged intervertebral disc and stabilizing the adjacent vertebrae with bone grafts or implants that are naturally fortified as the body heals after surgery. However, in order to successfully address neck or back pain through spinal fusion, a surgeon must first accurately identify the source of a patient’s pain. Furthermore, every patient heals at a different rate. Because vertebral fusion takes place as part of the healing process, it can take up to several months to achieve a solid fusion in some patients, while it never fully occurs in others.
  • Implant migration — Sometimes, an implant can shift after being placed by a surgeon. This most often occurs during recovery, before the body’s healing process has progressed to the point that the implant has attached firmly to the vertebrae. An implant that has moved out of its intended spot will be less effective — or completely ineffective — at stabilizing the spine. Moreover, if a displaced implant compresses sensitive neural tissue, it could create a painful new spine condition.
  • Scar tissue formation — As part of the natural healing process, the body forms bands of scar tissue following any form of tissue disturbance, such as spine surgery. These fibrous adhesions can potentially bind a nerve root, resulting in a condition called epidural fibrosis, which can lead to postoperative pain and FBSS.
  • Nerve damage — Decompressing a nerve root through spine surgery will typically cause temporary inflammation and can lead to increased pain until the inflammation subsides. However, in rare cases, nerve damage can occur, resulting in symptoms like chronic pain and weakness in certain muscle groups.

Traditional open spine surgery versus minimally invasive spine surgery

Open spine procedures have traditionally dominated the field of orthopedic spine surgery. However, the scientific knowledge base continues to grow and, due to recent advances in medicine and laser science, today’s patients have an effective alternative for treating FBSS in the form of minimally invasive spine surgery.

The minimally invasive, outpatient procedures perfected by the skilled surgeons at Laser Spine Institute are often the clinically appropriate first choice for addressing degenerative spine conditions. Additionally, minimally invasive techniques provide patients with many advantages over traditional open spine surgery, which generally requires large incisions and muscle disruption in order to provide surgeons with sufficient access to the spinal components. In contrast, minimally invasive spine surgery is performed using a tiny camera and micro-instruments that are inserted through small incisions. As a result, these procedures are much less invasive than traditional open back surgery.

As compared to traditional open spine surgery, minimally invasive spine surgery at Laser Spine Institute has been shown to offer patients several key advantages:

  • It is performed on an outpatient basis
  • Lower risk of infection and other complications
  • Minimal damage to surrounding bone, muscle and soft tissue
  • Less pain and scarring
  • Shorter and faster recovery

At Laser Spine Institute, we offer our minimally invasive spine surgery patients a streamlined experience, allowing them to avoid hospital-related costs and return to their lives and the things they enjoy as quickly as possible.

Solutions and treatment for failed back surgery syndrome, including surgery

Because FBSS is not one specific spine condition, each patient’s individual symptoms and history must be thoroughly reviewed and properly diagnosed in order to determine the best course of treatment. Contact Laser Spine Institute today for a review of your recent MRI or CT scan and to receive further information on our minimally invasive procedures.