Failed back surgery syndrome after non-instrumented lumbar surgery: Clinical report of a Tertiary care neurosurgical center

Abstract

Objective: This study aimed to determine the frequency, etiological spectrum, postoperative pain and functional outcomes of Failed Back Surgery Syndrome (FBSS) among patients undergoing non-instrumented lumbar decompression at a tertiary care neurosurgical center.

Methodology: A retrospective cohort study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar, from July 2021 to June 2025. Patients aged ≥ 15 years who had lumbar decompression without instrumentation because of degenerative spinal disease were enrolled, and those with congenital malformation, tumor, fusion, or premature loss to follow-up were excluded. A 12-month postoperative evaluation was then used to diagnose FBSS. Independent t-tests and chi-square tests were used to compare FBSS and non-FBSS groups and predictors of FBSS were determined using multivariable logistic regression. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used to measure pain and functional disability.

Results: Of 1,233 patients analyzed, 172 (13.9%) developed FBSS. The mean age was 48.51 ± 12.05 years, and 56.9% were male. No significant association was observed with age, BMI, gender, smoking, or depression (p > 0.05). The most frequent etiologies were recurrent disc herniation (36.0%), inadequate decompression (23.8%), and postoperative discitis (22.7%). FBSS patients had significantly higher pain and disability scores compared to non-FBSS patients (VAS 6.07 ± 1.79 vs. 2.09 ± 1.24; ODI 59.07 ± 10.40 vs. 22.15 ± 6.89; both p < 0.001).

Conclusion: FBSS was found in 14% patients after non-instrumented lumbar decompression. Recurrent herniation, incomplete decompression, and postoperative infection were the leading causes. Patients with FBSS demonstrated significantly higher pain intensity and functional disability compared with those without FBSS.