Decreased tibial nerve movement in patients with failed back surgery syndrome and persistent leg pain

  • G. ShumEmail author
  • S. Cinnamond
  • M. Hutton
  • D. Chan
  • R. Chauhan
  • S. Bloxham
  • S. Choy
  • R. Cheung
  • S. Eldabe
  • A. Clarke
Original Article



To measure and compare the total and normalised tibial nerve movements during forward bending in patients with and without failed back surgery syndrome (FBSS) and persistent leg pain following anatomically successful lumbar decompression surgery and demonstrated no psychological stress. Nerve pathomechanics may contribute to FBSS with persistent leg pain following anatomically successful lumbar decompression surgery.


Tibial nerve movement during forward bending was measured in two groups of patients following anatomically successful lumbar decompression surgery. FBSS group (N = 37) consisted of patients with persistent leg pain following lumbar surgery, and non-FBSS (N = 37) were patients with no remaining leg pain following lumbar surgery. Total and normalised tibial nerve movement at the popliteal fossa was measured by a previously validated ultrasound imaging technique and compared between the two groups, and also between the painful and non-painful leg within the FBSS group.


Both the mean total and normalised tibial nerve movement were significantly decreased in the FBSS group in both legs when compared to the non-FBSS group (P < 0.05). The total and normalised tibial nerve movements were also more restricted in the painful leg (P < 0.05) when compared to the non-painful side within the FBSS group.


This was the first study to quantify the decreased total and normalised tibial nerve mobility in FBSS patients with persistent leg pain when compared with non-FBSS patients following anatomically successful lumbar decompression surgery. Further research could investigate the efficacy of intervention, such as nerve mobilisation in this particular group of patients with failed back surgery syndrome and limited nerve mobility.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Failed back surgery syndrome Neuropathic pain Sciatica Nerve movement Post-operative pain 



The Royal Devon and Exeter NHS Foundation Trust, United Kingdom (13/SW/0029 and 14/NW/0110).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6056_MOESM1_ESM.pptx (380 kb)
Supplementary material 1 (PPTX 381 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Sport, Health and WellbeingPlymouth Marjon UniversityPlymouthUK
  2. 2.Exeter Spinal Unit, Princess Elizabeth Orthopaedic CentreRoyal Devon and Exeter NHS Foundation TrustExeterUK
  3. 3.Department of Rehabilitation SciencesThe Hong Kong Polytechnic UniversityKowloonHong Kong
  4. 4.Department of AnaesthesiaSouth Tees Hospitals NHS Foundation TrustMiddlesbroughUK

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