The dimensions of “failed back surgery syndrome”: what is behind a label?

Background The term failed back surgery syndrome (FBSS) has been criticized for being too unspecific and several studies have shown that a variety of conditions may underlie this label. The aims of the present study were to describe the specific symptoms and to investigate the primary and secondary underlying causes of FBSS in a contemporary series of patients who had lumbar spinal surgery before. Methods We used a multilevel approach along three different axes defining symptomatic, morphological, and functional pathology dimensions. Results Within the study period of 3 years, a total of 145 patients (74 f, 71 m, mean age 51a, range 32–82a) with the external diagnosis of FBSS were included. Disk surgery up to 4 times and surgery for spinal stenosis up to 3 times were the commonest index operations. Most often, the patients complained of low back pain ( n = 126), pseudoradicular pain ( n = 54), and neuropathic pain ( n = 44). Imaging revealed osteochondrosis ( n = 61), spondylarthrosis ( n = 48), and spinal misalignment ( n = 32) as the most frequent morphological changes. The majority of patients were assigned at least to two different symptomatic subcategories and morphological subcategories, respectively. According to these findings, one or more functional pathologies were assigned in 131/145 patients that subsequently enabled a specific treatment strategy. Conclusions FBSS has become rather a vague and imprecisely used generic term. We suggest that it should be avoided in the future both with regard to its partially stigmatizing connotation and its inherent hindering to provide individualized medicine.