Pain following back surgery

From Dr. med. Emmanuel Coradi 04.11.2020


Even after a carefully planned and surgically correctly performed back operation, persistent, chronic back pain can occur. This back pain is often accompanied by pain radiating to one leg. In certain patients, this radiating pain is even in the foreground. This symptomatology is called "Failed Back Surgery Syndrome" (FBSS).

Reasons for pain after back surgery

Patients are undergoing surgery due to severe acute or chronic pain in the spine. An important additional reason for the operation is pain radiating into a leg. Unfortunately, it is not uncommon that patients do not or only partially experience the expected improvement after back surgery. In English-speaking countries, this is called 'failed back surgery syndrome' (FBSS). 

In the course after the operation, the desired improvement in the pain problem does not occur. A variety of reasons can be responsible for such an unsatisfactory outcome. Despite careful medical examination and the most modern radiological methods (MRI), it is often difficult or even impossible to identify the anatomical cause of a back pain problem beyond doubt. However, due to the high level of suffering of affected patients, surgery is sometimes performed under these conditions. As a result, the optimal spinal surgical strategy is not selected for the operation and chronic back pain in the sense of FBSS is the consequence.

Increase in back surgery

Between 10 to 40% of the spinal operations performed do not lead to the desired success and result in an FBSS. Despite this balance, the number of back operations performed each year is increasing rapidly. The reasons for this development are manifold and cannot be explained by medical developments alone.

More back surgeries, less success

For decades it has been known that with every additionally performed back surgery, there is less hope for a life without back pain. After the first back surgery, 60 to 90% can expect an improvement in their back pain. If a second back operation is necessary, only 30% of patients benefit from a reduction in pain. With the fourth back surgery, only 5% of the affected patients benefit.

What to do?

The treatment of chronic pain after back surgery requires an interdisciplinary assessment by different specialists. Thus, an individually adapted therapy with various elements can be aimed for.

Conservative therapy
Training the back muscles is at the core of all therapeutic efforts. Well-trained back muscles can relieve the spine and thus reduce pain. Pain medication can be used as a supportive measure.

Radiofrequency treatment
Degenerative changes in the facet joints of the spine often play a crucial role in the pain process. Especially after spinal fusion operations, there is increased wear and tear of the facet joints of the subsequent vertebral bodies. In these cases in particular, radiofrequency treatment is an important option. The aim of radiofrequency treatment is the heat sclerosis of small nerves (medial branch nerves) that are responsible for transmitting pain signals from facet joints to the brain. If the affected medial branch nerves are successfully heat-sclerotised, there is an improvement in pain control. The improved pain control allows for more efficient training of the back muscles.

If conservative therapy and radiofrequency treatment do not provide sufficient pain control, neuromodulation treatment may be considered. In particular, patients with FBSS who suffer from pain radiation can benefit from neuromodulation treatment. Using a spinal cord stimulator, electrical impulses are delivered directly to the spinal cord, masking the pain impulses.


Nachemson AL. Evaluation of results in lumbar spine surgery. Acta Orthop Scand Suppl. 1993;251:130–133.

Thomson S. Failed back surgery syndrome: definition, epidemiology and demographics. Br J Pain. 2013;7:56–59.

Boden SD, et al., Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72(3):403-408.

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