Shamloo Elite Spine & Pain Institute
CONDITIONS / SPINE

Failed Back Surgery Syndrome

You had surgery because you wanted your pain to improve — but the pain is still there. Failed Back Surgery Syndrome describes persistent or recurrent pain after spine surgery. Despite its name, it does not necessarily mean that your surgery failed.

What Failed Back Surgery Syndrome is

Failed Back Surgery Syndrome (FBSS) is a term used to describe persistent or recurrent pain following one or more spine surgeries.

The name can be misleading. It does not necessarily mean that the surgery was performed incorrectly or that it failed to accomplish its intended purpose. In some cases, surgery successfully addressed the original structural problem, but the patient continues to experience pain for another reason.

Today, physicians may also use terms such as Persistent Spinal Pain Syndrome (PSPS) to describe ongoing pain after spine surgery.

Persistent pain following surgery can be physically and emotionally exhausting — particularly for patients who expected surgery to be the final step in their treatment.

Why does pain continue after back surgery?

The underlying cause may be related to the original condition, changes that developed over time, nerve damage, or a completely different pain generator. Potential causes include:

— Persistent or recurrent nerve irritation
— Scar tissue surrounding spinal nerves
— Recurrent or adjacent disc problems
— Stenosis or narrowing that develops at another level
— Facet joint pain
— Sacroiliac joint dysfunction
— Nerve damage before or around the time of surgery
— Persistent inflammation
— Changes in spinal mechanics
— Chronic neuropathic pain
— Recurrent or new spinal conditions

In some cases, imaging may show that the surgical site is structurally stable while the patient continues to experience significant pain. The presence of pain after surgery does not automatically mean another surgery is needed.

What pain after back surgery feels like

Persistent pain after spine surgery can take many forms. Patients may experience:

— Chronic lower back pain
— Leg pain or sciatica
— Burning or electric pain
— Shooting or stabbing pain
— Numbness or tingling
— Pain radiating into the buttocks, hips, or legs
— Pain with sitting, standing, or walking
— Muscle spasms or stiffness
— Pain that interferes with sleep
— Pain that returns after an initial period of improvement

Some patients experience predominantly neuropathic pain, which may feel burning, electrical, shooting, or unusually sensitive to touch. Others may have primarily mechanical or inflammatory pain — or a combination of several different pain generators.

When to seek specialized treatment

If you continue to experience significant pain after spine surgery, you don’t necessarily have to accept it as something you simply have to live with. A specialized evaluation may be appropriate when:

— Pain persists despite surgery
— Pain initially improved but later returned
— Leg or nerve pain continues after surgery
— You continue to require pain medication
— Previous injections or therapy have not provided lasting relief
— Pain interferes with sleep, work, exercise, or daily activities
— You have been told that additional surgery is not recommended
— You have undergone multiple spine surgeries and still have pain
— You are looking for alternatives to another spine operation

How FBSS is diagnosed

There is no single test that diagnoses Failed Back Surgery Syndrome. The first step is understanding why you are still experiencing pain.

Dr. Shamloo reviews your surgical history, previous imaging, medical records, current symptoms, and previous treatments. A detailed physical examination helps determine whether your symptoms appear to originate from the spine, spinal nerves, facet joints, sacroiliac joints, or another source.

When appropriate, updated imaging such as MRI or CT may be recommended to evaluate the surgical area and identify new or recurrent structural problems. Diagnostic injections or nerve blocks may also help identify specific pain generators.

The goal is not simply to determine that you still have pain after surgery. The goal is to determine what is causing that pain and what can realistically be done about it.

Advanced treatment options

Treatment depends on the underlying cause of your pain, your previous surgeries, your symptoms, and your overall health.

01
Targeted injections & nerve blocks
Can sometimes identify specific sources of persistent pain while also providing therapeutic relief — targeting spinal nerves, facet joints, the sacroiliac joint, or other structures.
02
Regenerative medicine
PRP and stem cell-based treatments may be considered for appropriately selected patients, particularly where degenerative changes, inflammation, or other musculoskeletal sources contribute to pain.
03
Spinal cord stimulation
A form of neuromodulation that uses a small implanted device to modulate pain signals before they are perceived by the brain — particularly for chronic nerve-related or radiating leg pain.
— You continue to have significant back or leg pain after surgery
— Your pain has a substantial neuropathic component
— Conservative treatments have not provided adequate relief
— Additional spine surgery is unlikely to provide meaningful benefit
— Your pain is interfering with your quality of life
— You are seeking an alternative to long-term medication management

SCS isn’t appropriate for every patient with persistent pain after spine surgery. The list above describes when it may be considered; a comprehensive evaluation is necessary to determine whether it — or another approach — is appropriate for your condition.

A personalized approach

Every patient who develops persistent pain after spine surgery has a different history. Some may benefit from a targeted injection or nerve block. Others may have a treatable structural problem that requires additional orthopedic or spine evaluation. For patients with chronic neuropathic pain, advanced neuromodulation may provide another path forward.

Dr. Shamloo takes the time to understand your previous surgery, your current symptoms, and the treatments you have already tried before developing a personalized plan.

The goal is not to assume that another surgery is the answer — or that nothing more can be done.

AN ADVANCED OPTION AFTER SPINE SURGERY
Spinal cord stimulation

For many patients with persistent neuropathic back or leg pain after spine surgery, SCS is one of the most important advanced treatment options available. Before permanent implantation, patients typically undergo a temporary trial to determine whether stimulation provides meaningful relief.

LEARN ABOUT SCS