For many individuals struggling with chronic back or leg pain, spine surgery offers a path toward relief and restored function. Yet for a small percentage of patients, pain returns—or never fully resolves—following a spinal procedure. This is known as Failed Back Surgery Syndrome (FBSS), a complex condition that affects both physical well-being and emotional health.

Failed back surgery often involves spinal pain originally present before the procedure, which may persist or even worsen after surgery.

At our Orange County spine center, we understand how frustrating and isolating this experience can be. Many patients with failed back surgery experience chronic low back pain as a primary symptom. Fortunately, there are clear steps you can take to evaluate what went wrong and move forward with a more personalized and effective treatment plan.

What Is Failed Back Surgery Syndrome?

Failed Back Surgery Syndrome refers to persistent or recurrent lumbar spinal pain following spine surgery, most often lumbar (lower back) procedures. The lumbar spine is the most common site for these surgical interventions and related complications. The term can be misleading—it does not imply that the surgeon did something wrong. Rather, it reflects the unfortunate reality that, in some cases, surgery does not fully address the source of pain or introduces new complications.

According to clinical literature, Failed Back Surgery Syndrome (FBSS), also known as failed back syndrome, may affect as many as 10% to 40% of individuals undergoing lumbar spine surgery.

What is considered a failed back surgery?

A surgical intervention is considered “failed” when it does not relieve pain for the patient’s preoperative symptoms, or when new symptoms emerge postoperatively. Sometimes the pain returns weeks or months later. In other cases, it may never go away at all. This may be due to nerve irritation, scar tissue formation, spinal instability, or incomplete decompression of a nerve root, and these issues can occur despite surgical intervention.

Why Does Back Surgery Sometimes Fail?

There are several possible reasons why spine surgery might not achieve the intended result:

  • Recurrent disc herniation
  • Epidural fibrosis (scar tissue compressing nerves)
  • Nerve injury or incomplete nerve decompression
  • Wrong-level surgery or misdiagnosed pain source
  • Hardware failure or spinal instability
  • Unaddressed lumbar spinal stenosis
  • Sacroiliac joint dysfunction (sacroiliac joint pain)
  • Adjacent segment degeneration

These complications can result in ongoing or new symptoms by causing pain through nerve compression, instability, or inflammation. Patient-related factors such as smoking, obesity, and psychological distress may also increase the risk of FBSS.

If you’re unsure whether a new or ongoing problem is related to surgery, these signs may help you determine if it’s time to revisit your diagnosis.

Symptoms of Failed Back Surgery Syndrome

What are the symptoms of failed back surgery syndrome?

Patients with FBSS typically report:

  • Persistent low back pain
  • Leg pain or sciatica
  • Neuropathic pain (burning, tingling, or numbness)
  • Muscle spasms, weakness, or balance problems
  • Pain that returns after an initial period of relief

Persistent pain can result in significant pain disability and low back pain disability, which may limit daily activities and reduce quality of life.

Some patients also develop emotional fatigue, depression, or fear of additional procedures after a disappointing outcome.

How Is FBSS Diagnosed?

Diagnosing FBSS involves a thorough evaluation of your prior surgical records, current symptoms, and a comprehensive physical examination. The physical examination plays a crucial role in the diagnostic process by helping to identify specific neurological deficits, rule out red flag symptoms, and provide valuable information to support the overall assessment, even if it may not always pinpoint the exact cause of pain.

Benign persistent back pain should also be considered as a possible diagnosis in patients with ongoing symptoms after surgery.

Evaluation and Imaging

  • MRI or CT scans to check for recurrent herniation, hardware problems, scar tissue, or to evaluate the spinal canal for narrowing (such as spinal stenosis) or other abnormalities
  • X-rays to assess spinal alignment or hardware placement
  • Nerve conduction studies or diagnostic nerve blocks to localize pain
  • Physical exam to assess reflexes, muscle strength, and sensation

The diagnostic process helps determine whether your symptoms are mechanical (due to spinal instability), neurologic (nerve compression), or inflammatory.

Nerve Injury and Failed Back Surgery Syndrome

Nerve injury plays a major role in many cases of failed back surgery syndrome (FBSS), and if you’re dealing with this condition, you’re likely experiencing chronic pain that just won’t go away even after your spinal surgery. Here’s what happens: during your spine procedure, those delicate nerve roots or even your spinal cord itself can get accidentally damaged. This damage might occur from direct trauma during the operation, ongoing compression that your surgeon wasn’t able to fully address, or the development of scar tissue (what we call epidural fibrosis) that essentially traps your nerves after everything heals.

When nerve injury happens to you, the symptoms can be particularly challenging to live with. You might experience sharp, stabbing, or burning pain that shoots from your back down into your legs, along with numbness, tingling, or muscle weakness that makes daily activities frustrating. These symptoms are especially distressing because they often signal neuropathic pain—and if you’ve tried treating this type of pain, you already know it’s notoriously difficult to manage with conventional pain medications alone.

To get an accurate picture of what’s happening with your nerves after back surgery, your pain physician will likely recommend some specialized testing. Electromyography (EMG) and nerve conduction studies (NCS) are the go-to tools here—they help your medical team pinpoint exactly which nerve roots are giving you trouble and create a treatment plan that’s tailored specifically to your situation.

Managing nerve injury in FBSS requires you to take a comprehensive approach, and the good news is there are multiple strategies that can help. Physical therapy becomes crucial for rebuilding your strength and mobility, while your pain management options include nonsteroidal anti-inflammatory drugs, specialized neuropathic pain medications, and interventional procedures like nerve blocks that can provide the relief you desperately need. For those dealing with stubborn chronic pain that doesn’t respond to other treatments, spinal cord stimulation offers an advanced solution that can actually interrupt those pain signals and significantly improve your quality of life.

Your best chance at avoiding long-term disability and persistent pain comes down to early recognition and treatment of nerve injury. By working closely with a multidisciplinary team—and this means collaborating with pain management specialists, physical therapists, and spine surgeons who understand your specific situation—you can access the full spectrum of care needed to address nerve injury and get back to functioning at your best.

Treatment Options for Failed Back Surgery

How do you treat failed back surgery syndrome?

Conservative treatments are often the first step in managing failed back surgery syndrome. Treatment should always be tailored to your symptoms, imaging findings, functional limitations, and the characteristics of the patient’s pain. Conservative treatment is generally considered a less invasive approach compared to surgical options and may include physical therapy, pain medication, and other nonoperative strategies.

Nonsurgical management options include physical therapy, medications, and minimally invasive procedures for patients who do not respond to medications or physical therapy. Pain medicine and pain medication are important components of symptom management and may be used in combination with other conservative treatments.

If conservative treatments and minimally invasive procedures fail to provide adequate relief, revision surgery or revision surgeries may be considered. However, it is important to note that the success rates of revision surgeries are limited, and the likelihood of achieving significant pain relief decreases with each additional procedure.

Surgical management and surgical treatment are higher-level interventions that may be considered when identifiable structural issues are present or when conservative treatment options have been exhausted. Specific surgical options include lumbar fusion surgery and lumbar spinal fusion, which may be appropriate for certain patients with persistent symptoms. Patients who underwent surgery, such as spinal surgeries or lumbar spine surgery, may require additional interventions if symptoms persist or recur.

Ultimately, the choice of treatment should be individualized, taking into account the patient’s pain characteristics and functional goals.

Nonsurgical Management

  • Physical therapy to strengthen the core and relieve pressure on spinal structures
  • Medication: NSAIDs, muscle relaxants, and neuropathic pain agents
  • Epidural steroid injections or nerve blocks to reduce inflammation
  • Pain psychology and cognitive behavioral therapy (CBT)
  • Lifestyle modifications including smoking cessation and weight loss

The Role of Neuromodulation

Is there hope after a failed back surgery?

Yes. One of the most promising options for persistent nerve-related pain is spinal cord stimulation (SCS)—a form of neuromodulation that sends electrical signals to interrupt pain transmission. For many patients with FBSS, SCS improves quality of life and reduces the need for medications.

Neuromodulation is especially helpful for neuropathic pain, and newer technologies (such as high-frequency or dorsal root ganglion stimulation) offer even more targeted relief.

Can Failed Spinal Fusion Be Fixed?

When is revision spine surgery necessary?

If hardware has shifted, failed to fuse, or if spinal alignment remains unstable, revision spine surgery may be required. This could include:

  • Removal or replacement of spinal hardware
  • Additional spinal fusion to stabilize a mobile segment
  • Decompression surgery to relieve newly developed or overlooked nerve compression

Choosing between traditional and minimally invasive spinal fusion requires a detailed evaluation. Read about the key differences between fusion approaches.

Is Failed Back Surgery Syndrome a Permanent Disability?

Not necessarily. While FBSS can be disabling, many patients improve with the right combination of conservative care, interventional therapies, and expert surgical review. Early re-evaluation, accurate diagnosis, and a multidisciplinary plan often lead to significant functional gains.

A Multidisciplinary Approach to FBSS

FBSS is best managed by a collaborative care team that may include:

  • Spine surgeons
  • Pain management specialists
  • Physical therapists
  • Psychologists or pain counselors

This team-based model improves outcomes by addressing the physical, emotional, and social factors that contribute to chronic pain.

Preventing Failed Back Surgery Syndrome

While not all causes of FBSS are avoidable, certain steps reduce risk:

  • Ensure your diagnosis is correct before surgery
  • Understand when surgery is truly indicated
  • Discuss long-term expectations with your provider
  • Prioritize minimally invasive techniques when appropriate
  • Follow post-operative care instructions carefully
  • Optimize your health before surgery

Explore common spine treatments and strategies

Moving Forward with Expert Care

Failed back surgery is not the end of your story. With an accurate diagnosis and a thoughtful care plan, many patients find substantial relief and improved function—even after a prior procedure didn’t deliver the results they hoped for.

If you’re living with pain after spine surgery, we invite you to request a consultation with Dr. Gerald Alexander. We specialize in diagnosing and treating complex spine conditions, including FBSS, and helping patients in Irvine and across Orange County get back to a life of mobility, purpose, and confidence.