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Failed spinal surgery syndrome.
Last reviewed: 04.07.2025
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In the English-language literature, the term "failed back surgery syndrome" (FBSS) is used - a syndrome of failed spine surgery, which is defined as long-term or recurring chronic pain in the lower back and/or legs after anatomically successful spine surgery.
This term covers a heterogeneous group of causes and residual symptoms after surgical treatment of lumbar spine pathology. Pain arising after surgical decompression of lumbar and sacral roots is a fairly common phenomenon. Recurrence of back pain after surgical treatment of herniated discs of the lumbar spine is noted in 5 to 38% of operated patients. Based on postoperative revisions of the spinal canal, it was suggested that recurrence of pain syndrome in 36.4% of operated patients is caused by cicatricial adhesive process in the epidural space, compressing the nerve root and the accompanying radicular artery, and in 28.2% - by a combination of cicatricial adhesive process with a small recurrence of the herniated disc.
The conducted studies have shown that the main causes of FBSS can be foraminal stenosis, internal destruction of the disc, pseudoarthrosis and neuropathic pain, which occur in more than 70% of cases. Pain can be caused by changes in almost all structures of the spinal column: intervertebral disc, synovial junction, muscles, ligaments, sacroiliac joint. With each of the encountered mechanisms (nerve root compression, arthritis, instability, disc degeneration, myositis, fasciitis, bursitis) the postoperative patient develops arachnoiditis and fibrosis With the use of devices for spinal fixation, new causes of pain have appeared.
In a significant proportion of cases of postoperative lumbosciatica, the only cause of its occurrence is "non-surgical" changes, among which are psychological causes, as well as so-called "musculoskeletal" changes, which are understood as degenerative-dystrophic changes both in the spine itself and the surrounding tissues, and pathogenetically associated changes in remote skeletal, articular and muscular-ligamentous structures. At the same time, it is not possible to indicate a single factor among all skeletal-articular and muscular-ligamentous changes in patients with lumbar lumbosciatica, with the exception of individual cases, since, apparently, in most cases a complex of causes is important.
The occurrence of lumbosciatica syndrome after decompression of lumbar and sacral roots may be associated with the presence of primary and satellite trigger zones, as well as comorbid disorders (depression and anxiety).
Treatment of patients with FBSS is often very difficult, as neither conservative therapy nor repeated spinal surgeries provide adequate pain relief. FBSS may occur in 30% of patients who have a typical set of problems: sleep disorders, depression, family, economic and social problems. Epidural spinal cord stimulation (SCS) is proposed as the most effective treatment for this group of patients. It is effective when analgesics, particularly opioids, are ineffective, when severe side effects occur or repeated spinal surgery is required.
The treatment algorithm for patients with FBSS should include: treatment of myogenic trigger zones and skin allodynia zones, trigger zones of postoperative scars, comorbid disorders (depression and anxiety), and a fitness program.