Failed back syndrome, post-laminectomy spine syndrome, or post-surgery spine syndrome all refer to a condition where the patient suffers from persistent back pain following spinal surgery. Often, this may result from surgeries to treat back pain. As explained by Follett and Dirks, two researchers in the field, it is the “surgical end stage after one or several interventions on the lumbar neuroaxis indicated to relieve lower back pain, radicular pain or the combination of both, without effect”.
The cause of the failed back syndrome is previous surgery. Particularly vulnerable groups are those who have had repeated surgery; this carries additional risk as each new surgery has a lower chance of reducing back pain.
- Previous spinal surgery
- Poor psychological well-being
- Inappropriate surgical choice
- Post-operative complications
Considering surgery may exacerbate the condition further or may not provide any additional benefit, conservative management is the first line where possible. This can include exercises to improve spinal mobility and strength.
Medical management focuses chiefly on pain management, such as the use of NSAIDs or anticonvulsants for neuropathic pain. Opioid treatment is not recommended long-term due to its side effect profile.
Surgical management is possible, but there are few indications. Most clinicians may take a cautionary approach to further surgical intervention as this may be of limited benefit to the patient. Alternatively, if the patient is eligible, they may recommend procedures such as screw removal.
Finally, techniques such as neuromodulation may be recommended, although evidence for their efficacy is not conclusive and may depend on the location of the pain.
Follett KA, Dirks BA. Aetiology and evaluation of the failed back surgery syndrome. Neurosurg Q. 1993;3:40–59.