Back surgery is meant to relieve pain, restore movement, and help you get your life back. When that doesn’t happen, it can feel confusing, discouraging, and isolating. Ongoing or recurrent pain after spine surgery is known as Failed Back Surgery Syndrome (FBSS), and it is more common than many people realize. FBSS can affect one in five patients who undergo spinal fusion procedures
In this guide, Dr. Todd Lanman explains what FBSS is, why it happens, and how careful re-evaluation and advanced, motion-preserving treatment strategies can address its underlying causes. The focus is not on repeating surgery for its own sake, but on identifying the true source of pain and selecting solutions designed to support durable relief and long-term spinal function.
What Is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome (FBSS) is the term used when significant back or leg pain continues, returns, or even worsens after spine surgery, instead of improving as expected. Use of the word “failed” is unfortunate, because Failed Back Surgery Syndrome does not necessarily mean the original surgery was done incorrectly. In fact, a newer term is increasingly used instead of FBSS, namely Persistent Spinal Pain Syndrome. This newer term is more accurate in that it the syndrome simply means the procedure did not achieve the hoped-for, long-term outcome in terms of pain relief or function.
People with FBSS may experience one or more of the following:
- Ongoing pain at or near the surgical site
- Radiating nerve pain, such as sciatica or pain traveling into the arm or leg
- Numbness, tingling, or weakness in the limbs
- Reduced ability to sit, stand, walk, or perform daily activities
- Emotional effects such as depression, anxiety, or frustration due to ongoing pain and loss of quality of life
Common Causes of Failed Back Surgery Syndrome
Common causes of Failed Back Surgery Syndrome often overlap, which means many patients have more than one issue contributing to their ongoing pain. Understanding these underlying problems is the first step in helping Dr. Todd Lanman design a targeted plan to relieve pain, restore function, and protect motion in the spine.
1. Incomplete Diagnosis or Inadequate Surgical Planning
Sometimes pain comes from more than one level or structure in the spine. Perhaps the first surgery only addressed part of the problem. When the true pain generator is missed or the surgical plan does not fully match the underlying condition, patients may continue to have the same symptoms or develop new ones after surgery.
2. Scar Tissue (Epidural Fibrosis)
As the body heals after spine surgery, it forms scar tissue around the surgical area, including near the spinal nerves. In some people, this scar tissue can tether or irritate these nerves, leading to ongoing back or leg pain even though the original disc or bone problem was treated.
3. Pseudarthrosis (Failed Fusion)
Fusion surgery is designed to fuse two or more vertebrae (spinal bones) together into one solid bone. If the bone graft does not fully heal, i.e., pseudarthrosis, the segment can remain unstable. This often causes persistent pain, stiffness, or hardware stress that feels similar to the original problem.
4. Adjacent Segment Disease (ASD)
When one spinal level is fused, nearby discs and joints may have to absorb more motion and stress. Over time, those adjacent levels can wear out faster, leading to new disc degeneration, arthritis, or nerve compression above or below the original fusion. Symptomatic adjacent segment disease occurs in 5–18% of fusion patients within 4–14 years, with higher rates (12–18%) in patients with instrumented fusion.
5. Hardware Malposition or Failure
Plates, screws, and rods are meant to stabilize the spine, but if they are slightly mispositioned, loosen, or break, they can irritate nerves, joints, or muscles. This can cause persistent pain at the surgical site, new nerve symptoms, or a feeling that the back or neck is unstable.
6. Spinal Instability or New Disc Herniation
Even after a technically successful surgery, other levels of the spine can become unstable or develop a new disc herniation. When a disc bulges or ruptures at a previously untreated level, it can compress nerves and recreate familiar symptoms like sciatica, arm pain, or weakness.
7. Incorrect Surgery Type (e.g., Fusion When ADR Was Better Suited)
In some cases, the procedure chosen does not align well with the patient’s anatomy, activity level, or long-term goals. For example, a patient who might have done better with a motion-preserving artificial disc replacement (ADR) may instead receive a fusion, which can reduce movement, increase stress on nearby levels, and contribute to long-term pain or adjacent segment problems.
When to Suspect FBSS
You might suspect Failed Back Surgery Syndrome if your recovery simply does not match what you were told to expect. Paying attention to these patterns can help you decide when it is time to seek a second opinion with a spine specialist like Dr. Todd Lanman.
Common warning signs include:
- Pain that never meaningfully improved after your surgery.
- Pain that initially got better, then gradually or suddenly returned.
- New or worsening nerve-related symptoms, such as numbness, tingling, burning pain, or weakness in your arms or legs.
- Imaging tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans that show ongoing or new structural problems in the spine.
- A history of one or more spine surgeries with little to no lasting relief, especially if each operation has provided shorter periods of improvement.
How Dr. Lanman Diagnoses the Root Cause
Finding the true cause of persistent pain after spine surgery is not always straightforward. It requires a combination of advanced imaging, specialized testing, careful review of your surgical history, and a thorough clinical examination. Dr. Todd Lanman takes a systematic, comprehensive approach to ensure nothing is overlooked.
Advanced Imaging and Movement Assessment
High-resolution magnetic resonance imaging (MRI) and computed tomography (CT) scans help define soft-tissue, bony, and hardware-related abnormalities. Dynamic X-rays—taken while you bend and move—assess spinal alignment and stability during movement, which static studies often miss.
Nerve Function Testing
When nerve injury or ongoing nerve irritation is suspected, electrodiagnostic testing such as electromyography (EMG) can clarify whether symptoms arise from active nerve compression, chronic nerve damage, or an unrelated condition elsewhere in the body.
Detailed Surgical Review
A meticulous review of your prior operative reports is equally important. Dr. Lanman examines exactly what was treated, what was left untouched, and how your spine has adapted since surgery. This detective work often reveals why earlier treatment fell short.
The 4D Health™ Evaluation
Many patients seek Dr. Lanman specifically for a second opinion after complex or unsuccessful procedures. His diagnostic process culminates in a comprehensive 4D Health™ evaluation, which examines your problem across physical, structural, functional, and lifestyle dimensions. By viewing your spine within the context of your whole life, including your work, activity level, goals, and medical history, Dr. Lanman can identify pain drivers that others may overlook and develop a plan that targets the root cause rather than just the symptoms.
Treatment Options to Fix Failed Back Surgery Syndrome
Non-Surgical Management (For Mild Cases)
For milder symptoms of Failed Back Surgery Syndrome, Dr. Todd Lanman often begins with non-surgical options designed to reduce pain, improve movement, and support healing. These approaches can also help determine whether more advanced interventions are truly necessary.
- Physical therapy focuses on gentle stretching, strengthening, and posture training to reduce strain on the spine, improve core support, and restore safer, more efficient movement patterns.
- Targeted anti-inflammatory injections or nerve blocks can calm irritated nerves and joints, often providing short- to medium-term relief that makes rehabilitation and daily activities more manageable.
- Pain management techniques may include tailored medications, activity modification, and strategies such as heat, ice, and relaxation or mindfulness-based approaches to help you stay as active and independent as possible while other treatments take effect.
Revision Spine Surgery
Revision spine surgery is focused on fixing the structural problems that were not fully resolved—or that developed—after the first operation. For many patients with Failed Back Surgery Syndrome, this type of precise “re-do” surgery is what finally addresses the true pain generator and restores stability.
- In some cases, revision surgery involves carefully removing scar tissue around nerve roots or taking out screws, plates, or rods that have shifted, loosened, or are causing irritation.
- If the spine is unstable because a fusion did not heal or a disc has deteriorated, Dr. Todd Lanman may re-stabilize the area with a more robust fusion, an artificial disc, or a combination approach tailored to your anatomy and goals.
- Revision procedures are also an opportunity to correct the original surgical issue such as incomplete decompression, untreated levels, or an approach that did not match your condition.
Artificial Disc Replacement (ADR) for Motion Preservation
Artificial disc replacement (ADR) is a motion-preserving surgery in which a worn or damaged spinal disc is removed and replaced with an artificial disc designed to move more like a natural one. In carefully selected patients, ADR can help maintain normal movement at the treated level while relieving nerve or disc-related pain and has a lower incidence of failed back surgery syndrome.
- In some cases, ADR can be used to revise a failed fusion or to treat adjacent segment disease, offering a way to restore motion at a previously fused or newly degenerated level instead of extending the fusion.
- Because ADR preserves movement at the operated segment, it can help maintain flexibility and may reduce the amount of extra stress placed on nearby spinal levels over time.
- Dr. Todd Lanman is widely recognized for his expertise in complex motion-preserving surgery, including multilevel ADR and fusion reversal procedures, and often cares for patients who have already had one or more prior spine operations.
Spinal Decompression (If Nerves Are Involved)
Spinal decompression focuses on giving crowded nerves more space so they can function without constant irritation. When done without removing too much bone or joint, it can relieve pressure on the nerve roots while keeping the overall stability of the spine intact.
Why Choose Dr. Lanman for Revision Spine Surgery
With more than 30 years of experience as a board-certified spinal neurosurgeon, Dr. Todd Lanman has dedicated his career to solving the most complex spine problems, including cases where prior surgeries have not delivered lasting relief. His practice is built around motion preservation and long-term spine health, making him a sought-after resource for patients whose pain has persisted despite one or more operations.
Dr. Lanman has served as a principal investigator in multiple United States Food and Drug Administration (FDA) clinical trials for artificial disc replacement devices, reflecting his deep expertise and leadership in this highly specialized field. He brings this same level of innovation to patients with Failed Back Surgery Syndrome and fusion failures, using advanced techniques such as multilevel ADR and fusion reversal to restore both comfort and mobility whenever safely possible.
Beyond his surgical skill, Dr. Lanman offers a concierge-style model of care with highly personalized treatment and recovery plans, close follow-up, and direct access for questions and concerns. This combination of technical excellence and individualized attention has made him a trusted spine surgeon for A-list entertainers, professional athletes, CEOs, and international patients who travel specifically to receive his care.
FAQs: Failed Back Surgery Syndrome
Can you fix failed back surgery?
Yes. In many cases, Failed Back Surgery Syndrome can be successfully treated through revision surgery, motion-preserving procedures such as artificial disc replacement, or targeted non-surgical therapies that address the specific cause of ongoing pain.
How do I know if my pain is from a failed fusion?
Persistent or worsening back or leg pain, limited mobility, weakness, numbness, or a grinding sensation in your spine after fusion surgery may indicate pseudarthrosis (failed fusion). Imaging such as CT scans, flexion–extension X-rays, or MRI can confirm whether the bones fused properly and identify instability or nerve compression.
Is revision surgery riskier than the first?
It often is. Revision surgery is generally more complex because of scar tissue and altered anatomy, and it does carry a slightly higher risk of complications such as dural tear or nerve injury compared to primary surgery. However, when performed by an experienced spine surgeon like Dr. Lanman, serious complications remain uncommon, and many patients achieve meaningful pain relief and improved function.
Can ADR be used after a failed fusion?
Yes. In carefully selected patients, artificial disc replacement can be used to revise a failed fusion or to treat adjacent segment disease, restoring motion at a previously fused or newly degenerated level instead of extending the fusion. Dr, Lanman has successfully “reversed” fusions and implanted artificial discs.
What happens if I don’t treat FBSS?
Untreated Failed Back Surgery Syndrome often leads to chronic pain, progressive disability, worsening mental health (including depression and anxiety), increased dependence on pain medications, and reduced quality of life. Early evaluation and treatment can help prevent these long-term consequences
Conclusion: You Don’t Have to Live in Pain After Spine Surgery
Failed Back Surgery Syndrome is a real, treatable condition, but only when the underlying cause is correctly identified and addressed. Dr. Todd Lanman will precisely diagnose your condition and design a tailored treatment plan using the most advanced, motion-preserving techniques available. Many patients who have already had one or more spine surgeries find that with the right diagnosis and the right surgeon, they can finally achieve lasting relief and return to an active, comfortable life.
Take the Next Step
Still in pain after spine surgery? You do not have to accept chronic pain as your new normal. Contact Dr. Todd Lanman’s Beverly Hills office today to schedule a confidential second opinion. During your consultation, Dr. Lanman will review your imaging, operative history, and current symptoms to determine whether advanced revision surgery, artificial disc replacement, or another motion-preserving approach can help restore your comfort, mobility, and quality of life. Let us help you move forward.
