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Onset of mental disorders in patients who developed failed back surgery syndrome



Failed back surgery syndrome (FBSS) is a complex and multifaceted condition associated with significant disability and morbidity. The purpose of this study was to investigate the association between FBSS with new incidences of mental health disorders.


Our cohort included patients diagnosed with FBSS within 12 months of a posterior fusion, laminectomy, or discectomy, identified using The International Classification of Disease, both Ninth and Tenth Revisions (ICD-9 and ICD-10). In the next step, both non-FBSS and FBSS-diagnosed patients were queried for the diagnosis of first-time occurrence of mental health disorders. The incidence of new mental health disorders was determined within 12-months following FBSS diagnosis.


FBSS patients were significantly at greater risk than non-FBSS patients of developing all included mental health pathologies: Depression: OR 1.9, 95% CI 1.8–2.0, p < 0.0001); Anxiety: OR 1.5, 95% CI 1.4–1.6, p < 0.0001; Sleep Disorder: OR 1.9, 95% CI 1.7–2.0, p < 0.0001; Bipolar Disorder: OR 1.7, 95% CI 1.5–2.0 p < 0.0001; PTSD: OR 1.5, 95% CI 1.3–1.8, p < 0.0001; Panic Disorder: OR 1.8, 95% CI 1.5–2.1, p < 0.0001; Suicidal Disorder: OR 1.7 95% CI 1.4–2.0, p < 0.0001, ADHD: OR 1.3, 95% CI 1.0–1.5, p = 0.0367.


In the current study, patients diagnosed with FBSS were at a significantly greater risk of developing mental health pathologies. While other studies have suggested pre-surgical psychological support and treatment, the current results suggest that a post-operative psychologic care may also be warranted. By identifying potential psychosocial unforeseen obstacles that occur in patients diagnosed with FBSS, more precise treatment pathways can be developed leading to improved patient outcomes.

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Availability of Data/Code

No patient identifiers were collected, as we used a publicly available nationally-representative database purchased through PearlDiver. No unique code was developed, and standard statistical software (RStudio) and tests were used.


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Correspondence to Zorica Buser.

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No conflict of interest. Disclosures outside of submitted work: JCW- Royalties – Zimmer Biomet, Seaspine, Depuy Synthes; Consulting: Precision OS (no money paid); Investments/Options – Bone Biologics, Pearldiver, Surgitech; Board of Directors—AO Foundation Board (honorarium), National Spine Health Foundation (non-financial, volunteer); Fellowship Funding (paid to institution): AO Foundation; Payment for expert testimony: various law firms. ZB- consultancy: Cerapedics (past), Research Support: SeaSpine (past, paid to the institution), Next Science (past, paid directly to institution), Medical Metrics (past, paid directly to institution), NIH SBIR grant (past, paid to institution); North American Spine Society: committee member; Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member; AOSNA Research committee- committee member.

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Stanton, E., Fresquez, Z., Muehlbauer, E.J. et al. Onset of mental disorders in patients who developed failed back surgery syndrome. Eur Spine J (2022).

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  • Failed back surgery syndrome
  • Postlaminectomy syndrome
  • Spine fusion
  • Mental health
  • Decompression