From the Guidelines
Failed back surgery syndrome (FBSS) occurs in approximately 10-40% of patients who undergo back surgery, with most studies suggesting an average rate of about 20-25%. This means that roughly one in four or five back surgeries does not provide the expected pain relief or functional improvement. The wide range in reported rates reflects variations in how FBSS is defined, the type of surgery performed, patient selection criteria, and follow-up duration.
Key Factors Influencing FBSS Rates
- Spinal fusion procedures tend to have higher failure rates compared to less invasive surgeries like microdiscectomy.
- Risk factors that increase the likelihood of developing FBSS include incorrect initial diagnosis, technical surgical errors, formation of scar tissue (epidural fibrosis), spinal instability, recurrent disc herniation, and psychosocial factors such as depression, anxiety, or unrealistic expectations about surgical outcomes.
- Patients with multiple prior back surgeries face progressively higher risks of developing FBSS with each additional procedure, which is why careful consideration of surgical candidates and thorough preoperative evaluation are essential for improving success rates.
Evidence-Based Recommendations
Based on the most recent and highest quality studies, such as 1, it is clear that the definition and management of low back pain play a crucial role in preventing FBSS. A practical approach to assessment, including a focused history and physical examination, can help determine the likelihood of specific underlying conditions and measure the presence and level of neurologic involvement.
Considerations for Clinical Practice
In clinical practice, it is essential to prioritize morbidity, mortality, and quality of life when making decisions about back surgery. This includes careful patient selection, thorough preoperative evaluation, and consideration of the potential risks and benefits of each surgical procedure. By taking a comprehensive and evidence-based approach, clinicians can help minimize the risk of FBSS and improve outcomes for patients undergoing back surgery.
From the Research
Failed Back Surgery Syndrome
- Failed back surgery syndrome (FBSS) is a common complication of lumbosacral spine surgery, with a frequency of 5%-10% 2.
- The exact percentage of back surgeries that end up with failed back syndrome can vary, but it is estimated to be around 5-10% 2.
Causes of Failed Back Surgery Syndrome
- The causes of FBSS can be multifactorial, including mistaken diagnoses, transoperative error, technique error, poor application, and poor indication 3.
- Poor indication and technique error are among the most common causes of FBSS 3.
Treatment Outcomes for Failed Back Surgery Syndrome
- Various treatments have been suggested for FBSS, including medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy 4.
- Epidural adhesiolysis and spinal cord stimulation have shown promising results in managing chronic back pain or leg pain due to FBSS, with recommendation grades of A and B, respectively 4.
- Pregabalin and gabapentin have also been shown to be effective in reducing pain associated with FBSS, with pregabalin being significantly more effective than gabapentin in some studies 5.