Conditions · Carrollwood · Tampa Bay
Failed Back Surgery Syndrome & Pain After Spine Surgery
What that label means, what your post-surgical report is describing, and how a doctor trained in spinal MRI interpretation examines you again, level by level.
You had the operation. You did the recovery. You still hurt, and then a chart note puts a name on it: failed back surgery syndrome, or post-laminectomy syndrome. The first word in it is failed, and the person holding that page is you. This page translates the rest. Dr. Bobby Koser, DC, chiropractic physician, completed post-doctoral training in spinal MRI interpretation and clinical correlation, and reading your imaging and operative report with the person they belong to is part of the examination here. Bring both.
Pain After Spine Surgery Overview
What the words on your report mean
A post-surgical spine report is written for the surgeon who operated and the physicians who follow you, not for you. It describes three things at once: the operation you had, what the tissue looks like now, and what has changed since the last picture.
Failed back surgery syndrome, or FBSS
A chart label for pain that continued or returned after spine surgery, written on some records as post-laminectomy syndrome and coded M96.1. It marks pain that is still there. It is not a grade of how hard you worked at your recovery, and it is not a verdict on your surgeon or on the operation you had.
In a 2021 paper in a pain medicine journal, an international group of pain and spine specialists wrote that failed back surgery syndrome is inadequate and misleading as a diagnostic label and that it misrepresents causation, meaning the name itself gives a wrong impression about what caused the pain. That group ranked 14 possible replacement names, narrowed the list to four, and chose persistent spinal pain syndrome through a structured workshop and consensus process, and proposed fitting that term into ICD-11, the World Health Organization’s classification of diseases, whose chronic pain section already offers chronic pain after spinal surgery as a suggested replacement for the older label.1 That paper is a group of specialists proposing what the condition should be called, not a study of patients, and it says nothing about any one person’s pain, treatment, or outcome. Persistent spinal pain syndrome is their proposal rather than an adopted code.
Also written as: failed back syndrome, failed back surgery, failed spine surgery, failed neck surgery syndrome, post-laminectomy syndrome, postlaminectomy pain syndrome, post-laminectomy syndrome lumbar or cervical region, M96.1, persistent spinal pain syndrome or PSPS, and chronic pain after spinal surgery or CPSS.
Laminectomy, discectomy, and the other words for what was done
The lamina is the bony arch at the back of a vertebra, roofing the canal your spinal nerves run through. A laminectomy removes part or all of that arch, a laminotomy a smaller window of it, a foraminotomy opens the side channel where a nerve root exits, and a discectomy or microdiscectomy removes disc material. Together these are called decompression, surgery to open space around the nerves. Post-laminectomy changes, postoperative changes, and laminectomy defect all describe where that bone or disc material is no longer there: the surgery you had, not a new finding on the scan.
Also written as: laminotomy defect, discectomy changes, post-surgical changes, posterior decompression.
Epidural fibrosis, scar tissue, and arachnoiditis
After spine surgery, fibrous tissue can sit in the epidural space, the layer of fat and veins between the bone and the sac holding your nerve roots. A report may call it epidural fibrosis, peridural or perineural fibrosis, epidural scar, or granulation tissue. Scar and disc material take up gadolinium, an MRI contrast dye, differently, which is how a radiologist tells them apart. Arachnoiditis names inflammation of the arachnoid, a thin membrane wrapping that sac, and reports sometimes describe the nerve roots inside as clumped. Whether any of this explains what you feel is a question for the examination, and a finding that shows up often after surgery does not make anyone’s pain less real.
Also written as: scar tissue after back surgery, adhesive arachnoiditis, clumping of the nerve roots, enhancing scar versus recurrent disc herniation.
Fusion, hardware, and pseudarthrosis
A fusion, also written arthrodesis, joins two or more vertebrae so they heal into one piece of bone, usually with a bone graft plus instrumentation, the hardware holding the level still while new bone forms: pedicle screws set into the bony stalks at the back of the vertebra, rods that connect them, and sometimes an interbody cage or spacer between the vertebral bodies. A solid bridge of bone across the level is reported as solid arthrodesis or bridging bone, and pseudarthrosis, also written nonunion, means that bridge is not seen. Loosening, lucency around the screws, migration, and subsidence describe where the hardware is sitting and how the bone around it looks. Whether a fusion is solid and whether an implant has moved are read from imaging by a radiologist and answered by your surgeon.
Also written as: failed fusion, hardware failure, broken rod, screw fracture, implant migration, cage subsidence, halo sign around the screws.
Adjacent segment degeneration and adjacent segment disease
The adjacent segment is the disc and the joints at the level directly above or below one that was operated on. Degeneration, shortened on some reports to ASDeg, describes wear findings a scan shows at that level. Disease, shortened to ASDis, is the word used when a person also has symptoms there. A report that uses the first has not established the second.
Also written as: adjacent level degeneration, transitional syndrome, junctional degeneration, and proximal junctional kyphosis, which describes a change in the curve of the spine at the top end of a fusion.
Recurrent and residual findings
Recurrent means disc material or narrowing is seen again at a level that was already operated on. Residual means the report is describing something still present there. Both are comparisons against an earlier picture. If either word appears next to a disc on your report, the plain-language walkthrough of protrusion, extrusion, and the rest is on our herniated and bulging disc page.
Also written as: recurrent disc herniation, residual disc herniation, recurrent herniation at the operated level, residual stenosis, restenosis, recurrent stenosis.
1. Christelis N, et al. Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11. Pain Med. 2021;22(4):807-818. PubMed
A finding is not a diagnosis
The level next to an operated one gets a lot of attention on post-surgical reports. In a review of 94 published studies covering 34,716 people after cervical or lumbar spine surgery, the individual studies disagreed widely with one another: changes seen on imaging at the segment next to an operated one ranged from 4.8% to 92.2% across studies, and symptoms attributed to that segment ranged from 0.0% to 30.3%.2 In that review, the pooled lumbar figures were about 27% of people for that imaging change and about 9% for symptoms attributed to that segment. In those studies, most people did not show that imaging change at all, and the pooled numbers are group estimates drawn from studies that did not agree.
That cuts in both directions, and both matter. A change that shows up on a scan is not automatically the source of your pain. And the reverse is just as true: pain that continues after surgery is not less real because similar pictures turn up on other people’s reports. The report is the starting point. The examination connects it to you.
2. Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(7):597-608. PubMed
The examination needs to know what was done, and where
A spine that has been operated on is not examined the same way as one that has not: what was removed, what was added, and which levels were involved change what gets tested. Bring the operative report, whatever imaging you have had since, your discharge instructions, and the restrictions your surgeon set. If you do not have them, records can be requested with your signature.
If you are still inside those restrictions, or have not been released yet, that comes first, and we ask your consent to contact the operating surgeon. If you have an implanted spinal cord stimulator or a pain pump, say so at the visit, and we ask to contact the physician who placed it first.
Symptoms, and the warning signs we screen for
Pain after spine surgery does not follow one script. It can sit in the low back or the neck, travel down a leg in the pattern many people know as sciatica or down an arm, or show up as hip and joint pain that started after the surgery. If what you have now reads mostly like low back pain or neck pain, those pages cover how each is examined. The visit works from where your pain sits now, what it does when you move, and whether the examination can reproduce it, not from the label on your chart.
Common, and examined here
- Back or neck pain that continued after an operation, or returned later
- Pain that has moved to a different place since the surgery
- Pain, tingling, or numbness running down a leg or an arm
- Stiffness or pain at the levels next to a fusion
- A post-surgical report nobody has explained to you
Emergency, not an appointment
- New loss of bowel or bladder control, or numbness in the groin, buttocks, or inner thighs
- Weakness in a leg or an arm that is getting worse quickly, or a foot that drags
- Fever, chills, or night sweats along with new or increasing back pain
- Redness, swelling, warmth, or drainage at the incision, or an incision that opens
- Clear fluid leaking from the incision, or a headache that comes on when you sit or stand and eases when you lie flat
- New trouble walking, loss of balance, or hands that have become clumsy after neck surgery
- Chest pain, shortness of breath, or new pain and swelling in one calf
Go to the emergency department now. Bowel or bladder changes with groin numbness can signal cauda equina syndrome, a surgical emergency, and fever or a wound that is changing can signal an infection. Screening for these is part of the examination here.
How we approach pain after spine surgery
The examination comes first: your history, what the pain was before the operation and what it is now, a physical and neurological examination, and your imaging and operative reports read with you, not at you. Dr. Koser’s post-doctoral training in spinal MRI interpretation and clinical correlation exists for exactly this conversation, and years of helping flag potential surgical spine cases for referral, alongside neurosurgeons, came before this practice. Does anything on these reports explain the person sitting in the room? That is the question the visit answers.
If what you want is a second read of your imaging, that is a reasonable thing to ask for and a reasonable reason to book. Bring the report, bring the disc if you have it, and bring your operative note. Reading it with you is part of the visit, not an add-on. What that conversation can settle is what the images show and whether conservative care has been fully worked through. What it cannot settle is whether to have another operation, which is a decision for a surgeon.
The examination does not stop at the operated level: the levels above and below it, the hip, and the sacroiliac joint, where the base of the spine meets the pelvis, are all tested. In a systematic review of people who had a fusion in the lower back, the authors described the sacroiliac joint as a potential source of low back pain that continues after that surgery, and they recommended that people with pain after this surgery be evaluated for sacroiliac joint pain.3 That evaluation is part of the examination here.
When conservative care fits, it is built from the examination and from what your spine has already been through: gentle techniques including flexion-distraction, which stretches the spine slowly with no thrust, instrument adjusting, soft-tissue work, and dry needling for the muscles guarding the area, with a plan for movement you can follow, monitored so it changes if you do not. Whether a given level is treated by hand at all is decided by the examination and the operative report. How the rest is structured is on our spine care page.
When the examination points somewhere else, we say so, refer you to the right physician, and send your records with you. That includes a neurological finding that is getting worse between visits, a question about the hardware or the fusion, and any of the warning signs above. Questions about medication go back to the prescriber. Whether another operation belongs in your future is a surgeon’s decision.
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3. Shen J, et al. Incidence of sacroiliac joint pain after lumbosacral spine fusion: A systematic review. Neurochirurgie. 2023;69(2):101419. PubMed
What the research shows
Both studies below are Cochrane reviews, summaries that pool randomized trials, studies where chance decides who gets which kind of care.
In a Cochrane review of 22 randomized trials covering 2,503 people after a first-time lumbar disc operation, a discectomy or microdiscectomy, surgery that removes disc material rather than fusing the spine, the review authors graded the overall evidence low to very low quality. With that grade on the table, here is the finding: exercise programs starting four to six weeks after the operation were associated with a faster decrease in pain and disability than no treatment, with small to medium effect sizes. Function was no different between the groups at long-term follow-up, and none of the trials reported an increase in reoperation, meaning a repeat operation, after first-time lumbar surgery.4
A second Cochrane review covered three randomized trials of 373 people after a first decompression operation, with or without fusion, for lumbar spinal stenosis, a narrowing of the canal in the lower back that the surgery opens up. Three trials is a small number, and the review authors said so, describing the clinical relevance of the effects as medium to small. In that review, moderate-quality evidence suggested that active rehabilitation was more effective than usual post-operative care for back-related function and for low back pain, both within six months of the operation and at 12 months. Leg pain showed no advantage over usual care in the first six months, and did at 12 months. General health did not improve more than with usual care, and none of the included trials reported any relevant adverse events from the rehabilitation programs.5
Both reviews describe groups in structured programs, not what will happen for you; what a program would look like in your case, and whether one fits within the restrictions your surgeon set, comes out of the examination.
4. Oosterhuis T, et al. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. 2014;2014(3):CD003007. PubMed
5. McGregor AH, et al. Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database Syst Rev. 2013;2013(12):CD009644. PubMed
Common questions about pain after spine surgery
Why do I still hurt after back surgery?
There is no single answer that fits everyone. Pain that continues or returns after an operation can involve the operated level, the levels next to it, the sacroiliac joint where the base of the spine meets the pelvis, the hip, the muscles guarding the area, or a nerve. The examination sorts out which.
My surgeon says the surgery looks fine on the scan, so why am I still in pain?
Both can be true at the same time. A scan can show exactly what was expected and you can still hurt: an image reports on tissue and an examination reports on a person. The visit here tests the levels above and below, the hip and sacroiliac joint, the muscles, and the nerves, to find what reproduces your pain.
Is scar tissue what is causing my pain?
A report can describe scar tissue in the epidural space, and on an MRI with contrast dye a radiologist can tell scar from disc material because the two take up the dye differently. What a scan does not settle is whether that tissue explains what you feel. That takes an examination, and a finding common after surgery does not make your pain less real.
Can a chiropractor treat me after a spinal fusion, and is it safe to be adjusted?
The examination decides that, and after a fusion it decides level by level rather than as one answer for your whole spine. This is where the operative report earns its keep: which levels were fused, what hardware is in place, and what restrictions your surgeon set. Several treatments used here involve no thrust, including flexion-distraction, instrument adjusting, and soft-tissue work.
Do I need another surgery?
That is a surgeon’s decision, and it is not made here. What happens here is an examination that either finds something conservative care can work with or finds a reason to send you back, and you get told which one it is. Measurable weakness or a question about the fusion or hardware goes back to a physician with your records.
What does post-laminectomy syndrome mean on my chart?
It is a chart label, coded M96.1, for pain that continued or returned after spine surgery. The laminectomy in it refers to the operation that removes part or all of the lamina, the bony arch at the back of a vertebra. The label describes a situation rather than a cause, and it is not something a radiologist saw on your images.
My pain is in my hip and buttock now instead of where it was before surgery. What is that?
A change in where your pain sits is a reason to be examined rather than a reason to assume anything. The examination tests the hip, the sacroiliac joint where the base of the spine meets the pelvis, the levels next to the one that was operated on, and the nerves that serve that area, then compares what it finds with your reports.
Can I still have an MRI with screws and rods in my back?
That is answered by the imaging facility and by your surgeon, because it depends on exactly what was implanted, which is named on your operative report. Metal also scatters the signal near hardware, something radiologists call susceptibility artifact, which is one reason a new scan is read alongside the earlier ones. Bring whatever imaging you have, along with the reports.
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This page is general health information and is not medical advice for any individual. The studies summarized describe groups, not any one person’s outcome, and whether any finding on your imaging explains your symptoms can only be determined by examination. Care here is provided alongside your operating surgeon’s follow-up and does not replace it. Talk to Dr. Bobby Koser, DC, about your own situation, and seek emergency care immediately for the warning signs listed above.
Bring all of it. Every report, every scan.
A complete examination with Dr. Bobby Koser, DC, your imaging and operative reports reviewed with you, and your findings explained the same day.