Clinical Insights and Statistical Analysis of Failed Back Surgery Syndrome: A Multicentric Retrospective Review

Failed back surgery syndrome (FBSS) is a well-documented yet underinvestigated phenomenon, with prevalence estimates ranging from 10 to 40% among all spine surgeries. FBSS contributes significantly to chronic pain and disability, leading to socioeconomic burdens. Studies have emphasized the multifactorial etiology of FBSS, including inadequate decompression, misdiagnosis, iatrogenic injury, and psychosocial contributors. However, there is a scarcity of large-scale, real-world clinical datasets offering multidimensional analysis of FBSS.

This retrospective study analyses 95 spinal surgeries performed between 2016 and 2024, with a focus on FBSS, defined as persistent or recurrent pain post-spinal surgery. Data include patient demographics, surgical techniques, recurrence rates, and complications.

The mean patient age was 56.2 years, with a female-to-male ratio of ∼1.2:1. The leading primary diagnosis was prolapsed intervertebral disc (60%), followed by lumbar canal stenosis (20%), traumatic pathology (10%), and tuberculosis-related or deformity cases (5%). The most frequent surgical procedures included posterior spinal fusion (30%), laminectomy (25%), and discectomy (20%). Approximately 40% of patients experienced full symptomatic relief, 30% reported partial relief, and 30% had unresolved or worsened symptoms. Complication rates included hardware failure (10%), dural tears/cauda equina syndrome (5%), infections (10%), and implant misplacements (8%). Revision surgery was required in 35% of patients, most commonly due to adjacent segment disease or implant-related failures, with an average interval of 2.3 years between primary and revision procedures. The study underscores the need for preoperative risk stratification, intraoperative precision, and multidisciplinary rehabilitation to mitigate FBSS.