Failed Back Syndrome

Relief for persistent or recurrent spine pain after surgical intervention

Failed Back Surgery Syndrome (FBSS), also referred to as post-laminectomy syndrome, describes persistent or recurrent back or leg pain following spinal surgery. Symptoms may occur immediately after surgery or develop months to years later due to evolving spinal changes.

FBSS does not necessarily indicate surgical error. Instead, it reflects the complex and multifactorial nature of spine pain and healing.

At Resolution Spine & Joint, we specialize in identifying the underlying causes of persistent post-surgical pain and developing individualized treatment strategies focused on restoring function and improving quality of life.

Common Symptoms

Patients with FBSS may experience:

• Persistent low back or neck pain

• Recurrent leg or arm radicular pain

• Burning, tingling, or numbness

• Muscle stiffness or guarding

• Activity limitation and reduced mobility

• Sleep disturbance and decreased quality of life

Symptoms often resemble pre-surgical pain but may also present with new or evolving patterns.

Why Pain Persists After Surgery

Several mechanisms may contribute to ongoing pain:

• Scar tissue formation (epidural fibrosis) irritating nerve roots

• Residual or recurrent disc herniation

• Adjacent segment degeneration

• Spinal instability or altered biomechanics

• Foraminal or central stenosis

• Facet joint overload following structural changes

• Sacroiliac joint stress after lumbar fusion

• Nerve sensitization and chronic pain signaling

Often, more than one factor contributes to symptoms, making comprehensive evaluation essential.

Common Post-Surgical Pain Patterns

Persistent Radiculopathy

• Continued nerve irritation despite decompression

• May result from scar tissue or residual narrowing

Mechanical Back Pain

• Facet joint or SI joint pain due to altered spinal mechanics

• Muscle fatigue and instability

Adjacent Segment Disease

• Degeneration above or below a fusion level

• New pain developing months or years after surgery

Neuropathic Pain

• Burning, hypersensitive nerve pain from prior nerve injury or chronic inflammation

Understanding the dominant pain pattern helps guide targeted treatment.

Diagnosis

Evaluation focuses on identifying the true pain generator rather than assuming surgical failure.

Assessment may include:

• Comprehensive history and physical examination

• Review of prior surgical details

• MRI imaging to evaluate scar tissue and structural changes

• CT imaging when hardware or bony anatomy must be assessed

• Diagnostic injections to isolate pain sources

Diagnostic blocks are particularly valuable in distinguishing nerve, joint, and muscular contributors.

Treatment Options at Resolution Spine & Joint

Treatment is individualized and often multidisciplinary.

Conservative Management

• Physical therapy focusing on stabilization and movement retraining

• Activity modification and biomechanical optimization

• Medication management when appropriate

Interventional Treatments

• Epidural steroid injections to reduce nerve inflammation

• Selective nerve root blocks for persistent radicular symptoms

• Facet joint and medial branch interventions for mechanical pain

• Sacroiliac joint injections when pelvic mechanics contribute

• Radiofrequency ablation for longer-term relief

When appropriate, referral for neuromodulation or surgical consultation may be considered.

Potential Consequences if Untreated

• Chronic pain and functional decline

• Reduced mobility and deconditioning

• Emotional distress and sleep disruption

• Increased reliance on medications

• Secondary joint and muscle dysfunction

Early identification and targeted treatment can significantly improve outcomes.

When to Seek Evaluation

Evaluation is recommended when:

• Pain persists after expected surgical recovery

• Symptoms recur months or years following surgery

• New pain patterns develop

• Functional limitation or neurologic symptoms worsen

Persistent post-surgical pain deserves careful reassessment rather than resignation.

Why Choose Resolution Spine & Joint

• Expertise in diagnosing complex post-surgical spine pain

• Advanced image-guided diagnostic and therapeutic procedures

• Comprehensive evaluation of nerve, joint, and muscular contributors

• Individualized care plans focused on restoring function and independence

• Compassionate approach recognizing the frustration and uncertainty associated with persistent pain

Patients with FBSS often feel discouraged, thoughtful evaluation and targeted treatment can restore both relief and confidence.

Frequently Asked Questions

Does FBSS mean the surgery was unsuccessful?
Not necessarily. Persistent pain often reflects complex spine mechanics rather than surgical error.

Can post-surgical nerve pain improve?
Yes. Many patients experience meaningful improvement with targeted treatment.

Is additional surgery always required?
No. Many cases can be effectively managed with non-surgical interventions.

Can injections still help after surgery?
Yes. Targeted injections can be highly effective in identifying and treating persistent pain sources.

References

• North American Spine Society (NASS)

• American Society of Interventional Pain Physicians (ASIPP)

• International Neuromodulation Society