Failed Back Surgery Syndrome (FBSS) refers to persistent back or leg pain after spinal surgery. It is common, with an estimated 35% success rate after lumbar fusion surgery. Risk factors include the type and number of previous surgeries. Diagnosis involves assessing pain location, imaging to rule out other causes, and diagnostic nerve blocks. Management uses a multimodal approach, including conservative care, medications, interventional procedures like injections, and revision surgery for select cases.

1. Failed Back Surgery Syndrome
Ade Wijaya, MD – April 2019

2. Definition
“An unsatisfactory outcome of a patient
who underwent spinal surgery,
irrespective of type or intervention area,
with persistent pain in the lumbosacral region
with or without it radiating to the leg”
Avellanal M, Diaz-Reganon G, Orts A, Soto S. One-year results of an algorithmic approach to managing failed back surgery syndrome. Pain Res Manag. 2014;19(6):313–316.
Hussain A, Erdek M. Interventional pain management for failed back surgery syndrome. Pain Pract.2014;14(1):64–78.

3. Postlumbar
surgery
syndrome
Postlaminectomy
syndrome
Failed back
syndrome
Postoperative
persistent
syndrome
Rigoard P, Desai MJ, Taylor RS. Failed back surgery syndrome: what’s in a name? A proposal to replace “FBSS” by “POPS” Neurochirurgie. 2015;61(Suppl 1):S16–S21.
Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011;12(4):577–606.

4. Introduction
› Back pain is a highly prevalent condition that can have a
tremendous social, financial, and psychological impact
on a patient’s life
› Low back pain is a worldwide problem, with an estimated
9.4% global incidence, creating more disability than any
other condition in the world
› High rate of surgery  Failed Back Surgery Syndrome
Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–974.

5. Epidemiology
Rajaee et al
• 170.9% increase of primary lumbar fusions from 77,682 to 210,407 between 1998 and 2008
• 11.3% increase in laminectomies from 92,390 to 107,790 between 1998 and 2008
Parker et al
• 5%–36% recurrence rate of back or leg pain 2 years after discectomy for disc herniation
Skolasky et al
• 29.2% of patients had same or increased pain 12 months after surgical laminectomy for lumbar
stenosis secondary to degenerative changes
Arts et al
• 35% success rate in terms of perceived recovery, functional disability, and pain. 15 months after
instrumented fusion for treatment of FBSS

6. Risk Factors
Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. Journal of pain research. 2016;9:979.

7. Diagnosis
Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. Journal of pain research. 2016;9:979.

8. Management
› Conservative
› Pharmacological
› Interventional pain procedures
› Revision surgery

9. Revision Surgery

10. Summary
› LBP – common
› Frequent surgery – high rate FBSS
› Multimodal treatment
› Revision surgery in selected cases