Failed Back Surgery Syndrome


Back surgery is often seen as a last resort for people living with chronic spine pain. But what happens when the surgery doesn't work—or worse, when the pain gets even worse afterward? This is the reality for many patients with Failed Back Surgery Syndrome (FBSS).

About 16 million adults in the US experience persistent or chronic back pain, making it the sixth most costly condition. While estimates suggest that 60% or more of initial back surgeries are successful, a significant number don't, potentially resulting in over 80,000 failed back surgeries each year (3). The International Association for the Study of Pain defines Post-laminectomy Syndrome, or Failed Back Surgery Syndrome (FBSS), as back pain, with or without referred or radiating pain mainly in the lower limbs, of unknown origin, that persists or begins after surgery for lumbar disc herniations (3). This challenging syndrome is reported to affect between 10 to 40% of patients post-surgery, leading to a lower quality of life, increased disability, and other issues (3). If you're among those experiencing ongoing or worsening back pain after surgery, you're not alone, and non-surgical options like chiropractic care may offer help.

 

Despite the name, FBSS doesn't necessarily mean the surgeon made a mistake. It simply means that the outcome didn't meet expectations—either the pain didn't improve, or it returned shortly after recovery. If you're living with lingering or worsening back pain after surgery, you're not alone—and there are non-surgical options that may help, including chiropractic care.

 

Common Symptoms of Failed Back Surgery Syndrome (FBSS)

The symptoms of FBSS can be varied and complex, often resembling the pain that led to the initial surgery or presenting in new ways. Common symptoms include:

 

  • Persistent or recurring lower back pain
  • Leg pain (sciatica) that may be different or similar to pre-surgery pain
  • Stiffness and reduced range of motion in the back
  • Muscle weakness in the legs or feet
  • Numbness or tingling sensations
  • Headaches
  • Fatigue

 

What Contributes to Failed Back Surgery Syndrome?

Several factors can contribute to the development of FBSS, including:

  • Incomplete Healing or Scar Tissue: The surgical site may not heal perfectly, leading to scar tissue formation that can compress nerves.
  • Recurrent Disc Herniation: The original disc problem may recur at the same or a nearby level.
  • Adjacent Segment Disease: Surgery at one level of the spine can sometimes increase stress and degeneration at adjacent levels.
  • Nerve Damage: Nerves may have been irritated or damaged during the surgical procedure.
  • Spinal Instability: The surgery might have inadvertently created or worsened instability in the spine.
  • Psychological Factors: Chronic pain can lead to depression, anxiety, and other psychological issues that can amplify the perception of pain.
  • Incorrect Initial Diagnosis: If the surgery didn't address the trustworthy source of the pain, symptoms will likely persist.

 

How Chiropractic Care May Help with Failed Back Surgery Syndrome

Chiropractic care offers a conservative approach to managing pain and improving function for some individuals experiencing FBSS. Chiropractors focus on the musculoskeletal system, particularly the spine, and aim to address issues that may be contributing to ongoing pain after surgery.

 

Research has shown that individuals with persistent pain after failed neck surgery have experienced improvements in neck pain and stiffness, discontinued pain medications, and improved their quality of life through chiropractic care (2). Patients in these studies have reported improvements in their pain and function (1). Based on these findings and the principles of chiropractic care, potential ways it may help with FBSS include:

 

  1. Pain Reduction:
    • Gentle chiropractic adjustments and mobilization techniques may help improve joint mobility in the spine and reduce mechanical stress, potentially alleviating pain.
  2. Restoring Spinal Alignment and Biomechanics:
    • Surgery can sometimes alter the biomechanics of the spine. Chiropractic care aims to optimize spinal alignment, which may reduce strain on the surgical area and surrounding tissues.
  3. Rehabilitation and Exercise Guidance:
    • Chiropractors can provide tailored exercise programs to strengthen core muscles, improve stability, and support long-term pain management.

 

Chiropractic Care as a Potential Option for FBSS Relief

Evidence suggests that chiropractic care, involving spinal manipulation and mobilization, may offer a safe and potentially beneficial non-pharmacological approach for some individuals seeking relief from FBSS (1). If you are experiencing persistent pain after back surgery, discussing the potential benefits of chiropractic care with a qualified chiropractor and your healthcare team may be a worthwhile step.