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What is Failed Back Surgery Syndrome?

Reviewed by Dr. Nileshkumar Patel, M.D., M.B.A.

Failed back surgery syndrome (FBSS) occurs when a patient continues to experience pain or disability after back surgery. Symptoms may include chronic or recurring pain and disability in the back, leg, or other affected areas after the surgery.

FBSS is a complex condition and can be challenging to diagnose and treat. Diagnosis typically involves a thorough physical examination, medical history review, and diagnostic imaging tests such as MRI or CT scans.

What are the causes of FBSS?

Pain can take a toll not only physically, but mentally as well. To help with this, you can suggest doing some low-impact activities with your loved one. Physically demanding activities can be an option as well but should be introduced slowly, to avoid exacerbation of their symptoms or triggering flare-ups. A few suggestions for low-impact activities include:

  • Excessive bleeding during surgery
  • Infection leading to inflammation and chronic pain
  • Damage to the spinal cord nerves or surrounding tissues
  • Postsurgical inflammation in the surrounding tissues
  • Scar tissue, which causes pressure on nerves, restriction of movement, and other issues

What are the treatment options for FBSS?

Treatment options for FBSS can vary based on a number of factors, including the patient’s symptoms and the severity of the condition. Patients should work closely with their healthcare providers to determine the most effective treatment approach for their particular circumstances and needs.

Common treatments may include:

Conservative treatments

  • Physical therapy
  • Chiropractic care
  • Acupuncture
  • Postsurgical inflammation in the surrounding tissues
  • Scar tissue, which causes pressure on nerves, restriction of movement, and other issues

Medications

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as Naproxen and Ibuprofen
  • Epidural steroid injections
  • Opioids
  • Antidepressants
  • Anticonvulsant medication

Surgical procedures

  • Repeat back surgery
  • Corrective back surgery

Pain Management

  • Spinal cord stimulation
  • Nerve decompression
  • Spinal fusion

Recent studies have revealed the limited success conservative care provides for FBSS patients.1,2,3 Prescription medications are not suitable for long-term pain management. The Center for Disease Control (CDC) 2022 Opioid Guidelines recommend non-opioid therapies to help manage chronic pain, lasting over three months.4

With Boston Scientific’s proven SCS therapy, patients receive personalized, lasting relief.

For individuals suffering from FBSS, Boston Scientific’s Spinal Cord Stimulation (SCS) therapy may significantly reduce their pain, increase their functional abilities, and improve their quality of life.

Boston Scientific’s SCS therapy is:

  • Safe
  • Drug-free
  • FDA-approved
  • Clinically proven to relieve chronic pain

Unlike most back surgeries, implanting an SCS System is a minimally invasive, reversible procedure. Patients have the added advantage of being able to see if SCS works for them before undergoing the implant procedure. An external trial system allows them to try SCS out for a few days too, so patients can see if SCS works for them before undergoing the implant procedure.

Boston Scientific SCS patients receive highly personalized pain relief with the WaveWriter Alpha™ Spinal Cord Stimulator (SCS) System. The device allows for precise pain targeting with sophisticated programming options. With the WaveWriter Alpha SCS System, targeted stimulation is tailored to meet each patient’s unique needs, resulting in increased pain relief and improved quality of life.

Get back to everyday activities

Effectively managing your pain can help you enjoy many things you’ve been missing. In a clinical study, patients using the Boston Scientific SCS therapy offered in the WaveWriter Alpha SCS System reported greater improvement in their daily activities than patients in other studies using non-Boston Scientific SCS Systems.5,6,7

Wondering if Spinal Cord Stimulation may be right for you?

Take this quick quiz and find out. ⟶

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References:

1. Desai MJ, Nava A, Rigoard P, Shah B, Taylor RS. Optimal medical, rehabilitation and behavioral management in the setting of failed back surgery syndrome. Neurochirurgie. 2015 Mar;61 Suppl 1:S66-76 2. Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017,15;42 Suppl 14:S41-S52 3. Klessinger S. Radiofrequency Neurotomy for the Treatment of Therapy-resistant Neck Pain after Ventral Cervical Operations. Pain Medicine 2010:11, 1504-1510 4. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1 5. Wallace MS, North JM, Phillips GM, Calodney AK, Scowcroft JA, Popat-Lewis BU, Lee JM, Washabaugh EP 3rd, Paez J, Bolash RB, Noles J, Atallah J, Shah B, Ahadian FM, Trainor DM, Chen L, Jain R. Combination therapy with simultaneous delivery of spinal cord stimulation modalities: COMBO randomized controlled trial. Pain Manag. 2023 Mar 3. doi: 10.2217/pmt-2022-0101. Epub ahead of print. PMID: 36866658. (N=59 at 24 months post implant). 6. Deer T, et al. Success Using Neuromodulation With BURST (SUNBURST) Study: Results From a Prospective, Randomized Controlled Trial Using a Novel Burst Waveform. Neuromodulation: Technology at the Neural Interface. 21. 10.1111/ner.12698 (N=95 at 3 months post implant). 7. Kapural, CY, et al. Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Lowfrequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial. Anesthesiology. 2015; 123:851-860 (N=92 at 3 months post implant).

Indications for Use: The Boston Scientific Spinal Cord Stimulator Systems are indicated as an aid in the management of chronic intractable pain of the trunk and/or limbs including unilateral or bilateral pain associated with the following: failed back surgery syndrome, Complex Regional Pain Syndrome (CRPS) Types I and II, intractable low back pain and leg pain, Diabetic Peripheral Neuropathy of the lower extremities, radicular pain syndrome, radiculopathies resulting in pain secondary to failed back syndrome or herniated disc, epidural fibrosis, degenerative disc disease (herniated disc pain refractory to conservative and surgical interventions), arachnoiditis, multiple back surgeries. The Boston Scientific Spectra WaveWriter™, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems are also indicated as an aid in the management of chronic intractable unilateral or bilateral low back and leg pain without prior back surgery.

Contraindications. The Spinal Cord Stimulator systems are not for patients who are unable to operate the system, have failed trial stimulation by failing to receive effective pain relief, are poor surgical candidates, or are pregnant.

MR Conditional symbol

Boston Scientific’s ImageReady™ MRI Technology makes safe MRI head scans possible. Patients implanted with the Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems with ImageReady™ MRI Technology are "MR Conditional" only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Head Only Guidelines for Precision Spectra™ or Spectra WaveWriter™ Spinal Cord Stimulator Systems.

MR Conditional symbolBoston Scientific’s ImageReady™ MRI Full Body Technology makes safe MRI scans possible. The Precision Montage™ MRI, WaveWriter Alpha™ and WaveWriter Alpha™ Prime SCS Systems with ImageReady™ MRI Full Body Technology are “MR Conditional” only when exposed to the MRI environment under the specific conditions defined in the applicable ImageReady™ MRI Full Body Guidelines for Precision Montage™ MRI or WaveWriter Alpha™ and WaveWriter Alpha™ Prime Spinal Cord Stimulator Systems.

Warnings. Patients implanted with Boston Scientific Spinal Cord Stimulator Systems without ImageReady™ MRI Technology should not be exposed to Magnetic Resonance Imaging (MRI). Exposure to MRI may result in dislodgement of the stimulator or leads, heating of the stimulator, severe damage to the stimulator electronics and an uncomfortable or jolting sensation. As a Spinal Cord Stimulation patient, you should not have diathermy as either a treatment for a medical condition or as part of a surgical procedure. Strong electromagnetic fields, such as power generators or theft detection systems, can potentially turn the stimulator off, or cause uncomfortable jolting stimulation. The system should not be charged while sleeping. The Spinal Cord Stimulator system may interfere with the operation of implanted sensing stimulators such as pacemakers or implanted cardiac defibrillators. Advise your physician that you have a Spinal Cord Stimulator before going through with other implantable device therapies so that medical decisions can be made and appropriate safety measures taken. Patients using therapy that generates paresthesia should not operate motorized vehicles such as automobiles or potentially dangerous machinery and equipment with the stimulation on. Stimulation must be turned off first in such cases. For therapy that does not generate paresthesia (i.e. subperception therapy) it is less likely that sudden stimulation changes resulting in distraction could occur while having stimulation on when operating moving vehicles, machinery, and equipment. Your doctor may be able to provide additional information on the Boston Scientific Spinal Cord Stimulator systems.  For complete indications for use, contraindications, warnings, precautions, and side effects, call 866.360.4747 or visit Pain.com. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Superion™ Indirect Decompression System (IDS) is indicated to treat skeletally mature patients suffering from pain, numbness, and/or cramping in the legs (neurogenic intermittent claudication) secondary to a diagnosis of moderate degenerative lumbar spinal stenosis, with or without Grade 1 spondylolisthesis, having radiographic evidence of thickened ligamentum flavum, narrowed lateral recess, and/or central canal or foraminal narrowing. The Superion™ Interspinous Spacer is indicated for those patients with impaired physical function who experience relief in flexion from symptoms of leg/buttock/groin pain, with or without back pain, who have undergone at least 6 months of non-operative treatment. The Superion Interspinous Spacer may be implanted at one or two adjacent lumbar levels in patients in whom treatment is indicated at no more than two levels, from L1 to L5. Contraindications, warnings, precautions, side effects. The Superion Indirect Decompression System (IDS) is contraindicated for patients who: have spinal anatomy that prevent implantation of the device or cause the device to be unstable in situ (i.e., degenerative spondylolisthesis greater than grade 1), Cauda equina syndrome, or prior decompression or fusion at the index level, scoliosis or spinous process fractures, osteoporosis, infection, allergy or reaction to any metal or implant or a high Body Mass Index. Avoid strenuous activity for 6 weeks after surgery, contact your physician if there is fluid leaking from your incision, if you have pain, swelling or numbness in your legs or buttocks or if you fall. Refer to the Instructions for Use provided on www.vertiflex.com for additional Indications for Use, contraindications information and potential adverse effects, warnings, and precautions prior to using this product. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

Indications for Use: The Boston Scientific Radiofrequency Generators, associated Radiofrequency Lesion Probes and RF Cannula are indicated for use in procedures to create radiofrequency lesions for the treatment of pain or for lesioning nerve tissue for functional neurosurgical procedures. The Boston Scientific RF Injection Electrodes are used for percutaneous nerve blocks with local anesthetic solution for radiofrequency lesioning of peripheral nerve tissue only. The Boston Scientific LCED and Stereotactic TCD Electrodes are indicated for use in radiofrequency (RF) heat lesioning of nervous tissue including the Central Nervous System.

Warnings: The Boston Scientific RF devices may cause interference with active devices such as neurostimulators, cardiac pacemakers, and defibrillators. Interference may affect the action of these active devices or may damage them. For appropriate guidance, consult the instructions for use for these active devices. Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.

§The physician locator tool identifies pain management specialists in your area who have met certain qualifying criteria and are experienced with one or more of Boston Scientific pain management therapies. All treatment options should be discussed thoroughly with a pain management specialist.