The Etiology and Treatment of Failed Back Surgery Syndrome in Patients with Primary Lumbar Fixation

Low back pain (LBP) ranks among the most common and debilitating musculoskeletal disorders worldwide, affecting about 9.4% of the population and imposing substantial social, economic, and psychological burdens. The aging population has led to a significant rise in chronic LBP and spinal surgical interventions. Nearly 10% of patients continue to experience symptoms beyond 3 months. The biomechanics of the lumbar spine, especially changes in the neutral zone, play a critical role in contributing to instability and pain. Despite advancements in surgical techniques, the success rates of repeat spine surgeries are declining. The objective of the above study was to evaluate the cause and treatment of failed back surgery.

This prospective observational analysis was conducted at a tertiary care teaching hospital from January 2021 to June 2022. The study included 26 adults with failed back surgery syndrome (FBSS) following lumbar fixation.

The straight leg raise test (SLRT) showed significant improvement in most patients over time after revision surgery. At the 3-month and 6-month follow-ups post-revision surgery, SLRT was free in the majority of patients (92.3% and 96.2%, respectively). Visual Analog Scale (VAS) and Oswestry disability index (ODI) scores significantly decreased between pre- and post-operative follow-ups at various intervals (P < 0.001). The percentage improvement in VAS and ODI scores was significant from 1 month to 6 months during follow-up. The VAS score improved by 62.5% at 1 month and 89% at the end of 6 months. The ODI score improved by 77% at 1 month to 97.3% at the end of 6 months.

This study demonstrates that revision spinal surgery - specifically utilizing the transforaminal lumbar interbody fusion technique - is a highly effective intervention for the management of FBSS.