FBSS Causes – Spine Center Atlanta

FBSS Causes

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What Causes Failed Back Surgery Syndrome?

Failed back surgery syndrome refers to any chronic or severe pain that occurs in the neck, back, legs, or hips after the patient has recovered from spine surgery. For those that struggle with debilitating back and neck pain, failed back surgery syndrome (FBSS) can be extremely stressful, as it means that the spine surgery was functionally unsuccessful.

No one wants to experience FBSS. But understanding the causes of failed back surgery syndrome can make it easier to understand why it occurred, and what failed spine surgery experts can do to treat it. Keep in mind that a personal diagnosis is important for determining the exact cause of your failed back surgery, so please call Spine Center Atlanta today at 404-620-5523 to schedule an appointment.

The following are some of the possible causes of FBSS. You can find more information about any of these causes by clicking on the link.

Structural Causes

Many of the causes of failed back surgery syndrome are structural, and directly related to changes in the that occurred either before, during, or after surgery. The structural causes of failed back surgery include disc herniation, stenosis, degenerated discs, and surgical errors that are apparent in scans. If the cause of failed back surgery syndrome is structural, surgery may be recommended, but non-surgical intervention may still be possible.

Read more about the structural causes of FBSS.

Non-Structural Causes

Causes of FBSS are not always clear on scans, and may not be the result of a structural issue with the disc, vertebrae, or nerves. When a specific structural issue cannot be found, orthopedic surgeons will then look for non-structural causes. Treatment for non-structural causes of FBSS may also be different, as surgery is not generally recommended as a first response.

Read more about the non-structural causes of FBSS.

Dural Tears After Back Surgery

There is a protective barrier covering the spine called the dura-mater. This barrier holds in cerebrospinal fluid, which covers the spinal cord. Usually, any tears in the dura-meter are repaired during the surgery. But in some cases, a surgeon can nick the dura meter without noticing it. These dural tears do not generally heal on their own, because they do not have adequate blood flow. But they can be repaired with the right techniques.

Read more about dural tears.

Epidural Fibrosis

Epidural fibrosis is the clinical name for scar tissue that builds up near the nerve root. The presence of scar tissue on its own is not necessarily a cause of failed back surgery syndrome since most surgeries have some scar tissue development. But depending on the location and severity of the scar tissue, FBSS may develop.

Read more about Epidural Fibrosis.


Infection is a risk with any type of surgery. But spinal surgery infections, especially when they occur deep inside of the body near the nerves, can be especially problematic. Deep infections are a complication that may require immediate surgery, not only to reduce pain, but also to prevent the spread of the infection.

Read more about infections and FBSS.

Neural Compressions

There is also a risk of nerve compressions, also known as compression neuropathy. There are several possible ways to develop neural compression after surgery, but one of the most common comes from adjacent segment disease, where nerves become more compressed in the discs of adjacent spinal segments, not necessarily the site of the initial surgery.

Read more about neural compressions and FBSS.


Arachnoiditis is the inflammation of the “arachnoid layer” of the meninges – a membrane that sits beneath the dural mater and protects the spinal cord. Spine surgery can cause the arachnoid layer to become inflamed, and this has been known to lead to pain, discomfort, and possibly the development of other conditions, such as sexual dysfunction and balance issues.

Read more about arachnoiditis and FBSS.

Recurrent Disc Herniation

Disc herniation is a common cause of FBSS. Some people undergo spine surgery to repair herniated discs, and if that surgery fails, the hernia may come back. But other types of surgery can cause recurrent disc herniation as well, especially if they do not heal correctly.

Read more about recurrent disc herniation and FBSS.

Pedicle Screw Failure

Pedicle screw failure is also a common cause of FBSS. That is because pedicle screws have a tendency to break or loosen in the bone, and that can lead to the development or chronic pain. Pedicle screw failure is so common, in fact, that Dr. Chappuis of Spine Center Atlanta personally invented (and hold patents on) pedicle screws that are less likely to fail. But since not all surgeons are using these screws, there remains an increased risk of problems.

Read more about pedicle screw failure and FBSS.

Hardware Failure

Many different spine surgeries involve hardware, such as plates, rods, artificial discs, and more. Unfortunately, any time a surgery relies on hardware, it is at the mercy of the quality of that hardware, and in some cases that hardware can break, or it can move from its original position, or it may simply be the wrong size and type for the surgery. These can all cause pain to come back.

Read more about hardware failure and FBSS.

Psychological Disorders

There are factors that can affect back and neck pain that are not necessarily related to the spine itself. For example, some psychological disorders can lead to the development of real, physical pain. Stress itself can slow or prevent healing after surgery. Depression and anxiety can sensitize the body so that it experiences more pain, even when that pain is not medically present. All of these mean that psychological disorders may be a cause of FBSS.

Read more about psychological disorders and FBSS.

Other Causes Of Failed Back Surgery Syndrome

Several conditions, like those above, may be responsible for the development of failed back surgery syndrome. But they are not the only causes. In fact, many causes of FBSS are not conditions at all. Rather, they are the result of two issues:

  • Misdiagnosis – A recurring problem in back surgery is misdiagnosis. Diagnosing back and neck pain is not like diagnosing other illnesses. Even good spine surgeons can miss the cause of the back pain, or they may not choose the right treatment to reduce it.
  • Surgical Error – There is also a risk of surgical error. Spine surgery requires incredible precision, and the slightest of mistakes can cause recurring and persistent back and neck pain. Above, we already mentioned dural tears, which are the result of accidental nicks of the dural mater, and an example of surgical error. There are also issues with surgery choices. Posterior lumbar fusion, for example, is used by 80% of spine surgeons, and yet has a higher failure rate than anterior fusion. Surgical error is an FBSS cause.

In order to thoroughly diagnose the cause of failed back surgery syndrome, however, it’s critical that you come in to speak with an FBSS expert directly and begin the process to diagnose the cause of failed surgery and the possible treatments to help relieve pain. For more information, please call us today at 404-351-5812.

FBSS Causes

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