Spine Surgery pp 613-620 | Cite as

Failed Back Surgery Syndrome: The Scar Is a Myth

  • Sebastian Ille
  • Sandro M. KriegEmail author
  • Bernhard Meyer


The term “failed back surgery syndrome” (FBSS) is wide-ranged and includes any sequelae following surgery of a lumbar disc herniation. Symptoms might be variable and multiple reasons exist, which can lead to a FBSS. Both the axial lumbar back pain as well as the persistent radiculopathy after surgery are symptoms of the FBSS. A large-scaled study could show that the FBSS depends on a recessal stenosis in 58% of cases, on a spinal stenosis in 7–14% of cases, on a new disc herniation in 12–16% of cases, on an arachnoiditis in 6–16% of cases, and on epidural scars in 6–8% of patients. As described later, the latter must be questioned. In most cases the pain occurs under stress and differs from the preoperative symptoms. Multiple operative and non-operative strategies can be chosen for the therapy of FBSS, but they only lead to a satisfying result if they are adapted to the underlying reason. Hence, making the diagnosis and the right indication particularly for the operative therapy of the FBSS is complex.


  1. 1.
    Onesti ST. Failed back syndrome. Neurologist. 2004;10(5):259–64.CrossRefGoogle Scholar
  2. 2.
    Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician. 2011;14(6):545–57.PubMedGoogle Scholar
  3. 3.
    Barth M, Diepers M, Weiss C, Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine (Phila Pa 1976). 2008a;33(3):273–9. Scholar
  4. 4.
    Barth M, Weiss C, Thome C. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine (Phila Pa 1976). 2008b;33(3):265–72. Scholar
  5. 5.
    Hossieni B, Dadkhah P, Moradi S, Hashemi SM, Safdari F. The results of treating failed back surgery syndrome by adhesiolysis: comparing the one- and three-day protocols. Anesth Pain Med. 2017;7(5):e60271. Scholar
  6. 6.
    Manchikanti L, Singh V, Cash KA, Pampati V, Datta S. A comparative effectiveness evaluation of percutaneous adhesiolysis and epidural steroid injections in managing lumbar post surgery syndrome: a randomized, equivalence controlled trial. Pain Physician. 2009;12(6):E355–68.PubMedGoogle Scholar
  7. 7.
    el Barzouhi A, Vleggeert-Lankamp CL, Lycklama a Nijeholt GJ, Van der Kallen BF, van den Hout WB, Jacobs WC, et al. Magnetic resonance imaging in follow-up assessment of sciatica. N Engl J Med. 2013;368(11):999–1007. Scholar
  8. 8.
    Wang JC, Dailey AT, Mummaneni PV, Ghogawala Z, Resnick DK, Watters WC 3rd, et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2014;21(1):48–53. Scholar
  9. 9.
    Steib K, Proescholdt M, Brawanski A, Lange M, Schlaier J, Schebesch KM. Predictors of facet joint syndrome after lumbar disc surgery. J Clin Neurosci. 2012;19(3):418–22. Scholar
  10. 10.
    Gornet MF, Burkus JK, Dryer RF, Peloza JH. Lumbar disc arthroplasty with Maverick disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine (Phila Pa 1976). 2011;36(25):E1600–11. Scholar
  11. 11.
    Zigler JE, Delamarter RB. Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. J Neurosurg Spine. 2012;17(6):493–501. Scholar
  12. 12.
    Jahng TA, Kim YE, Moon KY. Comparison of the biomechanical effect of pedicle-based dynamic stabilization: a study using finite element analysis. Spine J. 2013;13(1):85–94. Scholar
  13. 13.
    von Strempel A. Dynamic posterior stabilization with the cosmic system. Oper Orthop Traumatol. 2010;22(5–6):561–72. Scholar
  14. 14.
    Chou D, Lau D, Skelly A, Ecker E. Dynamic stabilization versus fusion for treatment of degenerative spine conditions. Evid Based Spine Care J. 2011;2(3):33–42. Scholar
  15. 15.
    Korovessis P, Papazisis Z, Koureas G, Lambiris E. Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine (Phila Pa 1976). 2004;29(7):735–42.CrossRefGoogle Scholar
  16. 16.
    Rickert M, Rauschmann M, Fleege C, Behrbalk E, Harms J. Interbody fusion procedures. Orthopade. 2015;44(2):104–13. Scholar
  17. 17.
    Liu HY, Zhou J, Wang B, Wang HM, Jin ZH, Zhu ZQ, et al. Comparison of topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease: a retrospective study. Chin Med J. 2012;125(22):3942–6.PubMedGoogle Scholar
  18. 18.
    Taylor RS, Van Buyten JP, Buchser E. Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: a systematic review and analysis of prognostic factors. Spine (Phila Pa 1976). 2005;30(1):152–60.CrossRefGoogle Scholar
  19. 19.
    Taylor RS, Desai MJ, Rigoard P, Taylor RJ. Predictors of pain relief following spinal cord stimulation in chronic back and leg pain and failed back surgery syndrome: a systematic review and meta-regression analysis. Pain Pract. 2014;14(6):489–505. Scholar
  20. 20.
    Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1–2):179–88. Scholar
  21. 21.
    Al-Kaisy A, Palmisani S, Pang D, Sanderson K, Wesley S, Tan Y, et al. Prospective, randomized, sham-control, double blind, crossover trial of subthreshold spinal cord stimulation at various kilohertz frequencies in subjects suffering from failed back surgery syndrome (SCS frequency study). Neuromodulation. 2018. Scholar
  22. 22.
    Sengupta DK. Is spinal cord stimulation a viable therapy for failed back surgery syndrome? No! Spine (Phila Pa 1976). 2018;43(7S Suppl 1):S15–s16. Scholar
  23. 23.
    Veizi E. Integration of spinal cord stimulation in treatment of failed back surgery syndrome. Spine (Phila Pa 1976). 2018;43(7S Suppl 1):S19–21. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sebastian Ille
    • 1
  • Sandro M. Krieg
    • 1
    Email author
  • Bernhard Meyer
    • 1
  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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