Dextrose injections for failed back surgery syndrome: a consecutive case series



Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS.


It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre- and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting.


There was statistically significant difference between repeated VAS and ODI measurements.


These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Dagenais S, Caro J, Haldeman S (2008) A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 8(1):8–20.

    Article  PubMed  Google Scholar 

  2. 2.

    Schofferman J, Reynolds J, Herzog R et al (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3(5):400–403

    Article  PubMed  Google Scholar 

  3. 3.

    Chan C-W, Peng P (2011) Failed back surgery syndrome. Pain Med 12:577–606

    Article  PubMed  Google Scholar 

  4. 4.

    Hussain A, Erdek M (2014) Interventional pain management for failed back surgery syndrome. Pain Pract 14:64–78

    Article  PubMed  Google Scholar 

  5. 5.

    Choi HS, Chi EH, Kim MR et al (2014) Demographic characteristics and medical service use of failed back surgery syndrome patients at an integrated treatment hospital focusing on complementary and alternative medicine: a retrospective review of electronic medical records. Evid Based Complement Altern Med 2014:714389

    PubMed  PubMed Central  Google Scholar 

  6. 6.

    Shapiro C (2014) The failed back surgery syndrome: pitfalls surrounding evaluation and treatment. Phys Med Rehabil Clin N Am 25(2):319–340

    Article  PubMed  Google Scholar 

  7. 7.

    Hazard RG (2006) Failed back surgery syndrome: surgical and nonsurgical approaches. Clin Orthop Relat Res 443:228–232

    Article  PubMed  Google Scholar 

  8. 8.

    Weir S, Samnaliev M, Kuo TC et al (2017) The rate of persistent post-operative pain (FBSS) in revision lumbar spinal surgery. Spine J 17(3):S10

    Article  Google Scholar 

  9. 9.

    Tronnier VM, Eldabe S, Franke J, Huygen F, de Andres Rigoard P, Ares J et al (2018) The appropriate management of persisting pain after spine surgery: a European panel study with recommendations based on the RAND/UCLA method. Eur Spine J 28(1):31–45.

    Article  PubMed  Google Scholar 

  10. 10.

    Seven MM, Ersen O, Akpancar S et al (2017) Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res 103(3):427–433

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Ersen O, Koca K, Akpancar S et al (2017) A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehab 64(1):i–xi

    Article  Google Scholar 

  12. 12.

    Akpancar S, Seven MM, Tuzun HY et al (2017) Current concepts of prolotherapy in orthopedic surgery. Arch Trauma Res 6(2):e40447

    Google Scholar 

  13. 13.

    Rabago D, Slattengren A, Zgierska A (2010) Prolotherapy in primary care practice. Prim Care 37(1):65–80

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Reeves KD, Topol GA, Fullerton BD (2008) Evidence-based regenerative injection therapy (prolotherapy) in sports medicine. In: Seidelberg PH, Beutler PL (eds) The sports medicine resource manual. Saunders, Philadelphia, pp 611–619

    Google Scholar 

  15. 15.

    Di Paolo S, Gesualdo L, Ranieri E, Grandaliano G, Schena FP (1996) High glucose concentration induces the overexpression of transforming growth factor-beta through the activation of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol. 149(6):2095–2106

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Murphy M, Godson C, Cannon S, Kato S, Mackenzie HS, Martin F et al (1999) Suppression subtractive hybridization identifies high glucose levels as a stimulus for expression of connective tissue growth factor and other genes in human mesangial cells. J Biol Chem. 274(9):5830–5834

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Krump E, Nikitas K, Grinstein S (1997) Induction of tyrosine phosphorylation and Na+/H+ exchanger activation during shrinkage of human neutrophils. J Biol Chem 272(28):17303–17311

    Article  CAS  PubMed  Google Scholar 

  18. 18.

    Lyftogt J (2008) Pain conundrums: which hypothesis? Central nervous system sensitization versus peripheral nervous system autonomy. Aust Musculoskelet Med 13(2):72

    Google Scholar 

  19. 19.

    Sanderson LM, Bryant A (2015) Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review. J Foot Ankle Res 8:57.

    Article  PubMed  Google Scholar 

  20. 20.

    Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H et al (2017) Short term analgesic effects of 5% dextrose epidural injections for chronic low back pain: a randomized controlled trial. Anesthesiol Pain Med 7(1):e42550.

    Article  Google Scholar 

  21. 21.

    Yelland MJ, Glasziou PP, Bogduk N, et al (2004) Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976) 29(1):9–16 (discussion 16)

    Article  Google Scholar 

  22. 22.

    Dagenais S, Yelland MJ, Del Mar C, Schoene ML (2007) Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 18(2):CD004059.

  23. 23.

    Guran S, Coban ZD, Karasimav O et al (2018) Dextrose solution used for prolotherapy decreases cell viability and increases gene expressions of angiogenic and apopitotic factors. Gulhane Med J 60:42

    Article  Google Scholar 

  24. 24.

    Hackett GS, Hemwall GA, Montgomery GA (1993) Ligament and tendon relaxation treated by prolotherapy, 5th edn. Gustav A. Hemwall, Oak Park

    Google Scholar 

  25. 25.

    Fairbank JCT, Pynsent PB (2000) The oswestry disability index. Spine 25(22):2940–2953

    Article  CAS  PubMed  Google Scholar 

  26. 26.

    Jamieson S (2004) Likert scales: how to (ab)use them. Med Educ 38(12):1217–1218

    Google Scholar 

  27. 27.

    Lee JH, Lee SH (2014) Clinical effectiveness of percutaneous adhesiolysis versus transforaminal epidural steroid injection in patients with postlumbar surgery syndrome. Reg Anesth Pain Med 39:214–218

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Hollingworth W, Turner JA, Welton NJ et al (2011) Costs and cost effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome. Spine 36:2076–2083

    Article  PubMed  Google Scholar 

  29. 29.

    Lad SP, Babu R, Bagley JH et al (2014) Utilization of spinal cord stimulation in patients with failed back surgery syndrome. Spine 39:E719–E727

    Article  PubMed  Google Scholar 

  30. 30.

    North RB, Kidd D, Shipley J et al (2007) Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery 61:361–368

    Article  PubMed  Google Scholar 

  31. 31.

    Manchikanti L, Abdi S, Atluri S et al (2013) An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician 16:S49–283

    PubMed  Google Scholar 

  32. 32.

    Chun-jing J, Hao-xiong N, Jia-ziang N (2012) The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome. Acta Cir Bras 27:357–362

    Article  PubMed  Google Scholar 

  33. 33.

    Manchikanti L, Boswell MV, Datta S et al (2009) Comprehensive review of therapeutic interventions in managing chronic spinal pain. Pain Physician 12:E123–E198

    PubMed  Google Scholar 

  34. 34.

    Fritsch EW, Heisel J, Rupp S (1996) The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine (Phila Pa 1976) 21: 626–633

    Article  Google Scholar 

  35. 35.

    Amirdelfan K, Webster L, Poree L et al (2017) Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine 42:S41–S52

    Article  PubMed  Google Scholar 

  36. 36.

    Louw A, Diener I, Landers MR et al (2014) Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine (Phila Pa 1976) 39:1449–1457

    Article  Google Scholar 

  37. 37.

    Brox JI, Reikeras O, Nygaard O et al (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122:145–155

    Article  PubMed  Google Scholar 

  38. 38.

    Jensen KT, Rabago DP, Best TM et al (2008) Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res 26(6):816–823.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Thomson S, Jacques L (2009) Demographic characteristics of patients with severe neuropathic pain secondary to failed back surgery syndrome (PROCESS study). Pain Pract 9:206–214

    Article  PubMed  Google Scholar 

  40. 40.

    Drucker M, Cardenas E, Arizti P et al (1998) Experimental studies on the effect of lidocaine on wound healing. World J Surg. 22(4):394–397 (discussion 397–8)

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Kim MY, Na YM, Moon JH (1997) Comparison on treatment effects of dextrose water, saline, and lidocaine for trigger point injection. J Korean Acad Rehabil Med 21(5):967–973

    Google Scholar 

  42. 42.

    Rabago D, Kijowski R, Woods M et al (2013) Association between disease-specific quality of life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil 94(11):2075–2082

    Article  PubMed  Google Scholar 

  43. 43.

    Panjabi M, Abumi K, Duranceau J et al (1989) Spinal stability and intersegmental muscle forces. A biomechanical model. Spine 14(2):194–200

    CAS  PubMed  Google Scholar 

  44. 44.

    Clemente CD (1985) Gray’s Anatomy, 30th edn. Lea & Febiger, Philadelphia

  45. 45.

    Yelland M, Glasziou P, Bogduk N, Schluter P, McKernon M (2004) Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine 29(1):9–16

    Article  PubMed  Google Scholar 

Download references


We all thank Michael Yelland, Associate Professor, MD, and John Lyftogt, MD, for their respected contributions to the designation of this paper.

Author information



Corresponding author

Correspondence to Özlem Yener-Karasimav.

Ethics declarations

Conflict of interest

İlker Solmaz, Serkan Akpancar, Aydan Örsçelik, Özlem Yener-Karasimav and Deniz Gül declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 152 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Solmaz, İ., Akpancar, S., Örsçelik, A. et al. Dextrose injections for failed back surgery syndrome: a consecutive case series. Eur Spine J 28, 1610–1617 (2019).

Download citation


  • Failed back surgery syndrome
  • FBSS
  • Prolotherapy
  • Dextrose
  • Injection