Failed Back Surgery Syndrome (FBSS) Symptoms

Before and after spine surgery the surgeon and other medical staff in charge of your care will prepare you for recovery—and for many people, that is a long and challenging time.

Pain after spine surgery is common, but how can you tell if it’s beyond the typical pain of recovery? What signs may indicate your spine surgery "failed"? Here, you’ll learn about the potential symptoms associated with failed back surgery syndrome (FBSS, also known failed back surgery or post-laminectomy syndrome).

Back Pain Is the Main Symptom but Not the Only One

The top complaint of people who have failed back surgery is chronic back pain. However, in cases of FBSS, the chronic pain in one patient can be very different from the pain experienced by another patient. People with FBSS can experience a range of different types of pain based on their spinal disorder, spinal procedure, and underlying cause of failed back surgery syndrome.

Below are the types of back and neck pain people with failed back surgery may experience. Some patients have one or more types.

• Chronic pain: Sustained, significant pain that lasts for more than 12 weeks. Chronic pain is the opposite of acute pain, which is short-term pain that may be severe. Acute pain is expected during spine surgery recovery, but the pain should fade as the spine heals.

• Nociceptive pain: Localized pain that may be dull or sharp. This is the type of pain patients may experience immediately after surgery (eg, the heightened pain felt around the incision site). When most people think of pain, nociceptive pain is what comes to mind.

• Neuropathic pain (neuropathy): Nerve-related pain is caused by damage to the nerves or spinal cord. Unlike nociceptive pain, which can be traced to a single site or area, neuropathic pain often shoots and moves, affecting large areas of the body. Examples of this type of pain include numbness, burning, tingling, weakness, and other abnormal sensations (called paresthesia).

• Radicular pain (radiculopathy): A subset of nerve pain (neuropathy) is called radiculopathy, or radicular pain. Radicular pain radiates from one area to another (eg, from the low back down the buttocks, legs, and feet, such as sciatica).

Other common symptoms of FBSS include:

• Original symptoms return: When the symptoms surgery intended to correct come back, it may indicate failed back surgery.

• New problems arise: Spine surgery may have fixed original symptoms, but new pain (pain in a different part of the spine or a different type of pain) warrants a discussion with your doctor.

• Reduced mobility: It takes time to recover from spine surgery and that process can affect your endurance, flexibility, and movement. However, reduced mobility or limitations in movement that is different from expected or develops after the recovery period should be discussed with your doctor. An example is limited range of motion in your neck or low back.

• Headaches develop: If they weren’t part of your medical history before your surgery, headache may signal a nerve problem after a cervical spine (neck) procedure.

Nerve-Related Symptoms of Failed Back Surgery Syndrome and Quality of Life

Neuropathic pain, also called neuropathy or nerve-related pain, is among the most complex, debilitating, and difficult-to-treat types of pain. People who experience this type of spine-related pain may find it lowers their quality of life.

A 2017 Japanese research study sought to better understand the nerve-related symptoms of failed back surgery. The researchers sent an online survey to 1,842 patients who underwent low back surgery, the responses revealed the following:

• 94% of respondents reported post-surgery low back pain

• 71.1% had dull ache

• 69.8% had numbness

• 43.3% had cold sensations

• 35.3% had paresthesia (eg, burning, prickly sensations)

“We found that residual abnormal sensations, such as numbness, coldness, or paresthesia in the lower extremities and dull ache in the low back were highly associated with patient satisfaction and quality of life following low back surgery,” wrote the research team.

A separate study on failed back surgery syndrome also noted that the nerve-related pain suffered by people who have FBSS is more life-altering than the pain caused by some of the most notoriously painful joint and nerve disorders.

“The prevalence and incidence of patients with FBSS are comparable with those of patients with rheumatoid arthritis,” wrote the study authors. “However, patients with FBSS and neuropathic pain experience higher levels of pain and a poorer quality of life and physical function compared with those with osteoarthritis, rheumatoid arthritis, complex regional pain syndrome, and fibromyalgia."

Failed Back Surgery Symptoms that Warrant Emergency Treatment

During spine surgery recovery, it may be difficult to identify whether your pain is within the bounds of “normal.” Scheduled follow-up appointments with your spine surgeon are a great time to check in and ask questions about the progress of your recovery and if any concerns exist.

Pain after spine surgery is normal, however, some signs and symptoms warrant emergency attention by your spine surgeon. If you experience any of the red flag symptoms below, call your doctor immediately:

• New weakness, difficulty walking, and electric-like pain in your lower body

• Fever, vomiting, and/or unintentional weight loss

• Loss of bowel or bladder function, which may be signs of a serious spinal nerve disorder called cauda equina syndrome

Symptoms of Failed Back Surgery Run a Wide Range

Every patient has a unique surgical experience—and if that surgery fails, patients may experience a unique set of symptoms. Because failed back surgery has several possible causes, the symptoms produced can vary greatly from patient to patient.

Before you are discharged home after spine surgery, ask your surgeon questions about what to expect during your recovery. What symptoms are normal? What symptoms warrant a call to the office? By arming yourself with the clearest possible expectations of your recovery, you’ll be best positioned to know when things aren’t going as they should.