Understanding Failed Back Surgery Syndrome: Causes, Symptoms, and Treatment Options

Failed back surgery syndrome (FBSS) can be one of the most devastating conditions anyone living with back pain can encounter. After dealing with chronic pain and other symptoms for years, patients can feel like they are at their lowest point if spine surgery isn’t effective or even makes the pain worse. Fortunately, there are effective treatment options and hope for anyone looking to overcome FBSS and achieve a better quality of life. 


What Is Failed Back Surgery Syndrome?


Failed back surgery syndrome describes complications or new symptoms that develop in the aftermath of a spine procedure. In some situations, patients may begin experiencing FBSS immediately after the procedure, or soon after recovery. In other cases, problems may not develop until weeks or months later, often making the condition difficult to diagnose and treat. 

FBSS may be more common than some realize. According to a 2023 study, failure rates may be as high as 25% for decompression procedures such as microdiscectomy and potentially up to 46% for lumbar fusions. 


Causes of Failed Back Surgery Syndrome


Failed back surgery syndrome is still being studied, and the causes are not fully understood. There can be a wide range of contributors and risk factors that can lead to the development of FBSS, including: 


  • Misdiagnosis: Not properly identifying the source of pain can lead to surgery on the wrong area or condition and the continuation of symptoms. 
  • Surgical error: Errors such as not fully removing damaged spinal tissue, nicking nerve tissue, or excessively damaging surrounding muscles and ligaments at the surgical site can cause increased pain or complications during recovery. 
  • Rejection of implants or failed fusion: In procedures involving surgical implants, the body may have an adverse reaction or the surgeon may not have implanted it properly, leading to potentially serious complications. And with some spinal fusion procedures, the vertebrae may not fully fuse, leading to a condition called pseudoarthrosis. 
  • Development of scar tissue: Whether due to surgical error, an increased risk of developing excessive scar tissue in the patient or long-term nerve damage, scarring in the surgical area can cause pain and is a key contributor to FBSS. 
  • Transfer of stress to a different level of the spine: Immobilizing one level of the spine in a spinal fusion can put more strain on the levels above and below. This can increase the risk of new pain and symptoms developing in these areas, especially if there is already degeneration present. 


Other risk factors can increase the likelihood of FBSS, including being overweight or obese, not following instructions during the recovery period, smoking and excessive alcohol consumption. Additionally, patients with mental health conditions such as depression and anxiety can be at an elevated risk for FBSS or experiencing more severe symptoms of the condition. 


Failed Back Surgery Syndrome Symptoms


Symptoms of failed back surgery syndrome can vary widely depending on the condition being treated, the procedure, and the cause or causes of the failed surgery. In some cases, FBSS pain may be the same symptoms from before the surgery, while in other situations, new or more severe pain may develop. Symptoms to watch for include:


  • Localized back pain
  • Severe shooting pain
  • Neuropathic symptoms such as tingling, numbness or muscle weakness
  • Development of a limp in the lower body 


Symptoms such as fever, chills, nausea or severe pain may be signs of an infection or other serious complication that constitutes a medical emergency. Patients should always err on the side of caution and contact their surgical provider or other health professional if something doesn’t feel right. 


Treatment Options for Failed Back Surgery Syndrome


As with symptoms, treatment can depend on the individual patient and diagnosis. In some cases, an immediate revision surgery may be required if there is a serious or life-threatening complication. In other situations, the best course of action will be to recommit to conservative treatment options including:



Followup surgery for FBSS is seen as a last resort treatment option. Especially because revision procedures for the same condition can have a decreased likelihood of success. But in some situations, minimally invasive surgery from a surgeon specializing in addressing FBSS may be the recommended course of action. 


Contact PPOA for Failed Back Surgery Syndrome Relief


If you’re living with FBSS or think you may have undergone an unsuccessful procedure, there is hope. The caring and dedicated team at Physician Partners of America (PPOA) specializes in helping people dealing with chronic FBSS pain find the treatment and relief they deserve. From nonsurgical pain management to FBSS surgery, we have the expertise to help you build an individualized treatment plan that is right for you. 


Contact us today to make an appointment and start your pain relief journey.