Revision Lumbar Spine Surgery for Failed Back Surgery Syndrome: A Retrospective Study of Causes, Complications, and...

Failed back surgery syndrome (FBSS) describes persistent, recurrent, or new-onset low back pain and/or radicular symptoms following lumbar spine surgery. Revision lumbar surgery remains challenging because of altered anatomy, epidural scarring, unclear tissue planes, and a higher risk of complications. Careful identification of a surgically correctable pathology is essential to improve outcomes.

The aim of this study was to evaluate the causes of failed previous lumbar surgery, indications for revision surgery, operative procedures performed, postoperative complications, and clinical and functional outcomes in patients undergoing revision lumbar spine surgery for FBSS.

This retrospective observational study included 150 patients who underwent revision lumbar spine surgery for FBSS between October 2017 and September 2023, with follow-up completed until September 2025. Patients were included if they had persistent or recurrent symptoms after previous lumbar surgery with radiological evidence of a surgically correctable pathology. Clinical data, operative findings, radiological diagnoses, complications, and follow-up outcomes were reviewed. Functional outcomes were assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) preoperatively and at three, 12, and 24 months postoperatively. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 29 (IBM Corp., Armonk, New York, United States), with p < 0.05 considered statistically significant.

The study included 84 male and 66 female patients, with a mean age of 41 ± 10.09 years. The most common presenting symptom was sciatica, reported in 63 patients (42%), followed by low back pain with sciatica in 45 patients (30%). The most frequently revised level was L4/L5 in 48 patients (32%). Incomplete decompression was the most common cause of failed previous lumbar surgery, identified in 42 patients (28%), followed by recurrent disc herniation in 39 patients (26%), retained disc fragment in 36 patients (24%), pseudoarthrosis or instrumentation-related failure in 24 patients (16%), and wrong-level surgery in nine patients (6%). Perioperative complications occurred in 69 patients (46%), with dural tear being the most common complication in 24 patients (16%). At three months, 93 patients (62%) were pain-free, increasing to 105 patients (70%) at 12 months, and maintained at 24 months. Sensory improvement occurred in 15 of 48 patients (31%), while motor improvement occurred in 21 of 39 patients (53%). The mean VAS score improved from 7.22 ± 0.89 preoperatively to 0.98 ± 0.75 at 24 months, and the mean ODI improved from 66.30 ± 9.06 to 7.77 ± 3.55. Improvements in both VAS and ODI were statistically significant (p = 0.001).

This study provides long-term evidence that revision lumbar surgery can achieve sustained improvements in pain and disability over 24 months in carefully selected patients with a surgically correctable pathology. It also demonstrates that potentially preventable technical factors, particularly incomplete decompression and retained disc fragments, represent important causes of failed previous surgery. These findings support the importance of accurate clinical-radiological correlation, careful patient selection, and meticulous surgical planning.