gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Failed Back Surgery Syndrome. A retrospective study in 180 surgical cases

Meeting Abstract

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  • corresponding author M. Bortoluzzi - Divisione di Neurochirurgia, Spedali Civili Brescia; Clinica Neurochirurgica, Università degli Studi di Brescia

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.03.03

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

Published: May 30, 2008

© 2008 Bortoluzzi.
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: The Failed Back Surgery Syndrome (FBSS) is a non-specific term. It implies that the final outcome of lumbar disk surgery is poor and requires two or more surgical treatments. The FBSS is due to different causes and is not a specific etiological, clinical or pathological entity. The only common denominator are several previous lumbar surgical procedures. Unfortunately this condition became so frequent that the FBSS is a “special pathological entity”. This is a retrospective study in 180 patients. The repeated operations were performed in five years, between 1997 and 2001. The follow-up time ranges from 6 to 11 years.

Materials: True recurrence of disc herniation occurred in 64 cases. 12 cases were revised after two operations performed in other Departments and 2 in our Clinic. Internal fixation (IF) with interbody cages and “reconstruction” of the lumbar lordosis was necessary in the remaining 102 cases. In 22 cases the causes of the IF were instability due to previous laminectomy (12 cases) or artrectomy (10 cases). Postoperative spondylodiscitis or deep wound infection were the cause in 6 patients. In the remaining 74 cases the cause was intractable lumbar and radicular pain after multiple disc revisions.

Results: No additional postoperative neurological deficits were observed and in all cases a normal neurological function or a relevant improvement of the preoperative neurological deficits was obtained. Epidural fibrosis or arachnoiditis were never the cause of the FBSS. In the group of true recurrence of disc herniation, good results were achieved in 58 cases (91%), but in the group of 2 previous revisions good results were obtained only in 8 cases (57%). In the group submitted to the IF, 79 patients (77%) were “satisfied”, the remaining 23 patients (23%) were “moderately satisfied”, but approved completely the surgical treatment.

Discussion: Our data demonstrate that three different concurrent factors play a special role in causing the FBSS: 1) the patient. Life style, behavior and motivations are crucial for good results (job, sport activity, weight, psychological conditions, litigations, etc).; 2) the lumbar pathology. Understanding and recognizing the spinal problems is a real difficult task. The knowledge of the role and mechanisms of the “Economic Balance” is essential for a appropriate surgical strategy. 3) the surgeon. Excellent clinical judgement is the more important factor in the choice of treatment. Long experience in spinal pathology and surgical techniques are imperative for continuing excellent results. After multiple lumbar surgeries, the cause of the FBSS is not the recurrence of a disc prolapse but the polysegmental dysfunction of the lumbar spine and consequent pathological conditions. So in our experience the only procedure with a very high percentage of durable good or satisfying results is the surgical reconstruction with internal fixation in order to obtain a new useful “Spinal Balance”.