The Failed Back

Due to the increasing prevalence of low back ache (LBA) and rising rates of spinal surgery, there has been a corresponding increase in complications following such procedures. Failed back surgery syndrome (FBSS) encompasses a broad and heterogeneous group of conditions where patients experience chronic pain after surgery or fail to achieve clinical improvement. The factors contributing to FBSS can be categorized into preoperative, operative, and postoperative stages, with patient psychosocial profiles, iatrogenic complications, poor decision-making, and long-term disease sequelae all playing a role in its development. Diagnosis typically involves radiography and contrast-enhanced magnetic resonance imaging (MRI). Local injections in the epidural space, facet joints, and sacroiliac (SI) joints serve both diagnostic and therapeutic purposes. Managing FBSS requires a multidisciplinary approach that includes pharmacological treatments, cognitive behavioral therapy (CBT) when appropriate, pain intervention procedures, and surgical revision in select cases.