gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

"Failed Back Surgery Syndrome": What is behind a diagnostic label?

„Failed Back Surgery Syndrom (FBSS)“: Was verbirgt sich hinter einem Namen?

Meeting Abstract

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  • corresponding author H.-H. Capelle - Klinik für Neurochirurgie, Medizinische Hochschule Hannover (MHH), Hannover
  • R. Weigel - Klinik für Neurochirurgie, Universitätsklinikum Mannheim
  • J. K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover (MHH), Hannover

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.03.05

The electronic version of this article is the complete one and can be found online at:

Published: April 11, 2007

© 2007 Capelle et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: "Failed back surgery syndrome" (FBSS) has been used as a diagnostic umbrella to cover painful conditions after back surgery. Both psychosocial problems and a variety of clinical symptoms may contribute to its manifestation. Treatment recommendations often have yielded frustrating results. This may be due, at least partially, to insufficient diagnostic clarification and specification of the underlying causes, to our opinion. Here, we report the differential diagnostic evaluation in a large series of FBSS in order to establish specific treatment options.

Methods: From 2001 to 2004, 154 patients (76 f/ 75 m, mean age 51, range 32-82 years) were admitted to our outpatient care center for further consultation with the diagnosis FBSS. Lumbar discectomies were performed in 110 patients, 38 were operated on spinal stensosis and 6 patients had undergone lumbar stabilization for spondylolisthesis. Most of them were operated in other hospitals. Our diagnostic work-up included detailed clinical examination, evaluation of pain profiles, myelography, functional x-ray studies. In addition a facet joint blockade of the rami dorsales was performed when diagnosis of lumbar facet syndrome was suspected.

Results: The following diagnoses were established: facet joint syndrome in 65 patients, recurrent disc herniation in 11 patients, lumbar instabilitiy in 30 patients and neuropathic pain in 47 patients. Independently of the primary diagnosis, 48 showed morphological signs of severe osteochondrosis. Facet joint blockade was performed in 60 patients of which 37 were positive. The diagnostic algorithm resulted in specific treatment in the majority of patients: reoperation for disc herniation in 11 patients, thermocoagulation in 30 patients, spinal reconstruction in 22 patients and dorsal column stimulation in 22 patients.

Conclusions: We think that the diagnosis of FBSS should not be the endpoint of patients with poor clinical outcome after spinal surgery. A thorough diagnostic re-evaluation will result in specific treatment.