- posted: Jul. 27, 2025
- News & Updates
Back pain is one of the most common reasons for seeking medical care, and in severe cases, surgery is recommended. However, for a significant number of patients, spine surgery does not result in the expected relief. In some cases, symptoms persist or even worsen—a condition known as Failed Back Surgery Syndrome (FBSS).
This article explores what FBSS is, why it happens, how common it is, and what conservative management options, including chiropractic care, may offer patients looking for relief.
✅ What Is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome (FBSS) is a term used to describe persistent or recurrent pain following spinal surgery, typically involving the lower back (lumbar spine). The pain may be similar to or worse than the original complaint that led to surgery.
According to the International Association for the Study of Pain, FBSS is defined as “lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location” (IASP, 2021).
📊 How Common Is FBSS?
FBSS is more common than most patients realize. Estimates vary depending on the type of surgery and patient population, but published data suggest:
10% to 40% of spinal surgeries result in FBSS (Chan & Peng, 2011).
Revision surgery often leads to diminishing returns—with lower success rates the second or third time around (Kuslich et al., 1991).
One study showed that up to 20% of spinal fusions result in chronic pain and dysfunction (Fritzell et al., 2001).
⚠️ Common Causes of FBSS
Several factors can contribute to ongoing pain after spinal surgery:
🔹 1. Incorrect diagnosis or surgical target
If the true source of pain wasn't properly identified (e.g., the pain was muscular, facet joint-related, or neuropathic), surgery on a disc may not resolve the issue.
🔹 2. Scar tissue and adhesions
Post-operative scar formation, such as epidural fibrosis, can compress nerve roots and recreate pain.
🔹 3. Spinal instability or altered biomechanics
Surgery may alter spinal alignment, leading to new stress points and compensatory strain elsewhere in the spine.
🔹 4. Adjacent segment degeneration
Surgical fusion often leads to accelerated degeneration of spinal segments above or below the fusion site.
🔹 5. Psychosocial factors
Chronic pain can be worsened by depression, anxiety, fear-avoidance behavior, and loss of function or livelihood.
🔄 The Cycle of Repeat Surgeries
Unfortunately, patients with FBSS are often offered additional surgeries. But the success rate of revision spine surgery is markedly lower:
| Surgery Attempt | Expected Success Rate |
|---|---|
| First surgery | ~50–70% |
| Second surgery | ~30% |
| Third surgery | ~15% |
| Fourth surgery | ~5% |
(North et al., 1991)
As the number of surgeries increases, so do complications, scar tissue formation, opioid dependence, and disability.
🧠 Managing FBSS Without More Surgery
Given the limited success of repeat operations, many patients and providers are turning to conservative, multidisciplinary approaches to manage FBSS.
🔹 Physical therapy
Custom stretching, stabilization, and postural exercises can improve mobility and reduce inflammation.
🔹 Cognitive Behavioral Therapy (CBT)
Addressing the psychological component of chronic pain has been shown to improve pain perception and function.
🔹 Spinal cord stimulation
In some cases, electrical implants offer relief by modulating pain signals, but these are invasive and expensive.
🌿 Chiropractic Care for FBSS: A Conservative Option
Chiropractic care may play a valuable role in managing post-surgical back pain, particularly when focused on regions adjacent to the surgical site.
Chiropractic can help:
Improve spinal mobility and segmental motion above or below the fusion.
Reduce soft-tissue tension and inflammation.
Provide posture correction, ergonomic coaching, and rehabilitative exercise.
Offer non-pharmacologic, opioid-free pain relief strategies.
A study by Cox and Bakkum (2005) demonstrated that flexion-distraction chiropractic technique helped reduce pain and improve function in post-surgical patients with lumbar FBSS.
Another study by Kruse and Cambron (2011) found that patients with prior low back surgery who received chiropractic care showed significant improvements in pain and quality of life, with no serious adverse events reported.
Caveat:
Chiropractic treatment in FBSS cases must be individualized and cautious—avoiding direct manipulation at the surgical level, using modified techniques, and working closely with imaging and clinical history.
🚫 Opioids Are Not the Solution
Patients with FBSS are often prescribed opioids for long-term pain control. However, long-term opioid use is associated with:
Tolerance and dependence
Cognitive and hormonal impairment
Increased risk of overdose and death
The CDC recommends non-opioid therapies—including spinal manipulation—as first-line options for chronic low back pain (Dowell et al., 2016).
✅ Conclusion
Failed Back Surgery Syndrome is a complex, multifactorial condition that requires a multidisciplinary and conservative approach. While surgery can be life-changing for some, it is not always successful—and repeat procedures carry lower odds of success and higher risks.
Chiropractic care, when carefully applied, may offer safe, effective, and non-invasive options for FBSS patients seeking relief without more surgery or opioids.
References
Chan, C. W., & Peng, P. (2011). Failed back surgery syndrome. Pain Medicine, 12(4), 577–606.
Cox, J. M., & Bakkum, B. W. (2005). Chiropractic management of post-surgical lumbar spine pain using flexion-distraction technique: A retrospective study. Journal of Manipulative and Physiological Therapeutics, 28(9), 595–603.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624–1645.
Fritzell, P., Hagg, O., Wessberg, P., & Nordwall, A. (2001). Chronic low back pain and fusion: A comparison of three surgical techniques. Spine, 26(23), 2521–2534.
Kruse, R. A., & Cambron, J. A. (2011). Characteristics of chiropractic patients with chronic low back pain and prior lumbar spine surgery. Journal of Manipulative and Physiological Therapeutics, 34(7), 408–414.
Kuslich, S. D., Ulstrom, C. L., & Michael, C. J. (1991). The tissue origin of low back pain and sciatica. Orthopedic Clinics of North America, 22(2), 181–187.
North, R. B., Kidd, D. H., Zahurak, M., James, C. S., & Long, D. M. (1991). Spinal cord stimulation for chronic, intractable pain: Experience over two decades. Neurosurgery, 28(5), 692–699.
International Association for the Study of Pain. (2021). Failed back surgery syndrome.
- posted: Jul. 27, 2025
- News & Updates
Back pain is one of the most common reasons for seeking medical care, and in severe cases, surgery is recommended. However, for a significant number of patients, spine surgery does not result in the expected relief. In some cases, symptoms persist or even worsen—a condition known as Failed Back Surgery Syndrome (FBSS).
This article explores what FBSS is, why it happens, how common it is, and what conservative management options, including chiropractic care, may offer patients looking for relief.
✅ What Is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome (FBSS) is a term used to describe persistent or recurrent pain following spinal surgery, typically involving the lower back (lumbar spine). The pain may be similar to or worse than the original complaint that led to surgery.
According to the International Association for the Study of Pain, FBSS is defined as “lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location” (IASP, 2021).
📊 How Common Is FBSS?
FBSS is more common than most patients realize. Estimates vary depending on the type of surgery and patient population, but published data suggest:
10% to 40% of spinal surgeries result in FBSS (Chan & Peng, 2011).
Revision surgery often leads to diminishing returns—with lower success rates the second or third time around (Kuslich et al., 1991).
One study showed that up to 20% of spinal fusions result in chronic pain and dysfunction (Fritzell et al., 2001).
⚠️ Common Causes of FBSS
Several factors can contribute to ongoing pain after spinal surgery:
🔹 1. Incorrect diagnosis or surgical target
If the true source of pain wasn't properly identified (e.g., the pain was muscular, facet joint-related, or neuropathic), surgery on a disc may not resolve the issue.
🔹 2. Scar tissue and adhesions
Post-operative scar formation, such as epidural fibrosis, can compress nerve roots and recreate pain.
🔹 3. Spinal instability or altered biomechanics
Surgery may alter spinal alignment, leading to new stress points and compensatory strain elsewhere in the spine.
🔹 4. Adjacent segment degeneration
Surgical fusion often leads to accelerated degeneration of spinal segments above or below the fusion site.
🔹 5. Psychosocial factors
Chronic pain can be worsened by depression, anxiety, fear-avoidance behavior, and loss of function or livelihood.
🔄 The Cycle of Repeat Surgeries
Unfortunately, patients with FBSS are often offered additional surgeries. But the success rate of revision spine surgery is markedly lower:
| Surgery Attempt | Expected Success Rate |
|---|---|
| First surgery | ~50–70% |
| Second surgery | ~30% |
| Third surgery | ~15% |
| Fourth surgery | ~5% |
(North et al., 1991)
As the number of surgeries increases, so do complications, scar tissue formation, opioid dependence, and disability.
🧠 Managing FBSS Without More Surgery
Given the limited success of repeat operations, many patients and providers are turning to conservative, multidisciplinary approaches to manage FBSS.
🔹 Physical therapy
Custom stretching, stabilization, and postural exercises can improve mobility and reduce inflammation.
🔹 Cognitive Behavioral Therapy (CBT)
Addressing the psychological component of chronic pain has been shown to improve pain perception and function.
🔹 Spinal cord stimulation
In some cases, electrical implants offer relief by modulating pain signals, but these are invasive and expensive.
🌿 Chiropractic Care for FBSS: A Conservative Option
Chiropractic care may play a valuable role in managing post-surgical back pain, particularly when focused on regions adjacent to the surgical site.
Chiropractic can help:
Improve spinal mobility and segmental motion above or below the fusion.
Reduce soft-tissue tension and inflammation.
Provide posture correction, ergonomic coaching, and rehabilitative exercise.
Offer non-pharmacologic, opioid-free pain relief strategies.
A study by Cox and Bakkum (2005) demonstrated that flexion-distraction chiropractic technique helped reduce pain and improve function in post-surgical patients with lumbar FBSS.
Another study by Kruse and Cambron (2011) found that patients with prior low back surgery who received chiropractic care showed significant improvements in pain and quality of life, with no serious adverse events reported.
Caveat:
Chiropractic treatment in FBSS cases must be individualized and cautious—avoiding direct manipulation at the surgical level, using modified techniques, and working closely with imaging and clinical history.
🚫 Opioids Are Not the Solution
Patients with FBSS are often prescribed opioids for long-term pain control. However, long-term opioid use is associated with:
Tolerance and dependence
Cognitive and hormonal impairment
Increased risk of overdose and death
The CDC recommends non-opioid therapies—including spinal manipulation—as first-line options for chronic low back pain (Dowell et al., 2016).
✅ Conclusion
Failed Back Surgery Syndrome is a complex, multifactorial condition that requires a multidisciplinary and conservative approach. While surgery can be life-changing for some, it is not always successful—and repeat procedures carry lower odds of success and higher risks.
Chiropractic care, when carefully applied, may offer safe, effective, and non-invasive options for FBSS patients seeking relief without more surgery or opioids.
References
Chan, C. W., & Peng, P. (2011). Failed back surgery syndrome. Pain Medicine, 12(4), 577–606.
Cox, J. M., & Bakkum, B. W. (2005). Chiropractic management of post-surgical lumbar spine pain using flexion-distraction technique: A retrospective study. Journal of Manipulative and Physiological Therapeutics, 28(9), 595–603.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624–1645.
Fritzell, P., Hagg, O., Wessberg, P., & Nordwall, A. (2001). Chronic low back pain and fusion: A comparison of three surgical techniques. Spine, 26(23), 2521–2534.
Kruse, R. A., & Cambron, J. A. (2011). Characteristics of chiropractic patients with chronic low back pain and prior lumbar spine surgery. Journal of Manipulative and Physiological Therapeutics, 34(7), 408–414.
Kuslich, S. D., Ulstrom, C. L., & Michael, C. J. (1991). The tissue origin of low back pain and sciatica. Orthopedic Clinics of North America, 22(2), 181–187.
North, R. B., Kidd, D. H., Zahurak, M., James, C. S., & Long, D. M. (1991). Spinal cord stimulation for chronic, intractable pain: Experience over two decades. Neurosurgery, 28(5), 692–699.
International Association for the Study of Pain. (2021). Failed back surgery syndrome.