What it is
"Failed back surgery syndrome" is a clinical description rather than a diagnosis — it refers to persistent or recurring back or leg pain after lumbar spine surgery that has not met the patient's or surgeon's expectations. It is common: a meaningful percentage of patients who undergo lumbar spine surgery continue to have significant pain.
The reasons are varied and not always correctable with additional surgery:
- Recurrent disc herniation at the same or adjacent level
- Scar tissue (epidural fibrosis) encasing a nerve root
- Adjacent segment disease — degeneration above or below a prior fusion
- Spinal instability inadequately addressed by prior surgery
- Hardware failure or pseudarthrosis (failed fusion)
- The original pain generator was not the one treated
Evaluation
Thorough evaluation before any further intervention is essential. This includes careful review of prior imaging and operative reports, new MRI to assess current anatomy, and often a period of conservative management. Determining whether there is a correctable structural problem — and whether correction is likely to improve the patient's specific symptoms — is the critical question.
Repeat surgery
Repeat lumbar spine surgery can be appropriate and beneficial when there is a clear structural problem that matches the patient's symptoms. It is rarely beneficial as a "try something" approach when the source of pain is unclear. The outcomes of revision spine surgery are generally less predictable than primary surgery, and this must be part of an honest preoperative discussion.
Spinal cord stimulation is a well-established option for patients with persistent radicular leg pain after failed lumbar surgery who are not candidates for or do not wish to pursue further surgery.