Failed Back Surgery Syndrome

A July 2022 paper (1) describes failed back surgery syndrome treatment this way: “Failed back surgery syndrome (FBSS) is associated with persistent lower back pain after and despite one or more surgical interventions. A number of factors underlie and maintain FBSS and successful management of pain chiefly depends on identifying them. Pharmacological, surgical, and non-surgical therapeutic measures are taken to treat the pain. Spinal cord stimulation and nerve stimulation have been widely practiced in this regard and enhanced pain reduction and patient satisfaction. In hernia and recurrent disc degeneration and sagittal imbalance, discectomy and/or fusion are indicated.”

Conservative care treatments

Pharmaceutical

A May 2022 update in STATPEARLS, (3) a book of the National Library of Medicine writes: “Studies of conservative treatment specifically for failed back surgery syndrome are rare, and the studies that do exist are often contradictory. Common pharmacologic treatments include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, anticonvulsants, and antidepressants. NSAIDs are commonly prescribed drugs for many different etiologies of lower back pain, for which they have been shown to have an advantage over placebo. While opioids are commonly used to treat chronic pain, evidence for their use in FBSS is generally weak, and the risk of dependence and resultant substance use disorder must be strong consideration before their use.

Because there was little long-term data on Spinal cord stimulation  in helping patients with failed back surgery syndrome, doctors conducted patient reviews in people who had spinal cord stimulation devices, some for 20 years or more. In this May 2022 study (2), researchers looked at overall patient satisfaction, pain intensity, and adverse events for 191 patients who received a permanent SCS implant. Secondary health measures included the influence of opioid and nicotine use on pain reduction after therapy.

  • 78.5% of the patients were satisfied with the treatment outcome, with a significant pain reduction of an average three points on a Numeric Rating Scale (0-10).
  • Opioid and nicotine usage did not have a significant link with the pain reduction one year after the treatment.
  • Devices had an average battery lifespan of 8.4 years. A total of 248 revisions were recorded. A total of 24 patients (11.7%) acquired an infection; 7 of 204 patients had an infection during the trial period, 2 of 191 patients had an infection in the first postoperative year, and 15 of 191 patients had an infection after the first year. The average time to infection, if not in the first year, was 10.1 years.

Conclusions: “A successful long-term outcome regarding pain relief in patients with predominant radicular pain due to FBSS is established with SCS therapy.”


1 Alizadeh R, Sharifzadeh SR. Pathogenesis, etiology and treatment of failed back surgery syndrome. Neurochirurgie. 2021 Sep 17.
2 Puylaert M, Nijs L, Buyse K, Vissers K, Vanelderen P, Nagels M, Daenekindt T, Weyns F, Mesotten D, Van Zundert J, Van Boxem K. Long-Term Outcome in Patients With Spinal Cord Stimulation for Failed Back Surgery Syndrome: A 20-Year Audit of a Single Center. Neuromodulation: Technology at the Neural Interface. 2022 May 14.
3 Orhurhu VJ, Chu R, Gill J. Failed Back Surgery Syndrome. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

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