Failed Back Surgery Syndrome (FBSS) Treatment in Castle Rock
What is Failed Back Surgery Syndrome?
Failed back surgery syndrome (FBSS), also called post-laminectomy syndrome, is the term used when a patient continues to have significant pain after spine surgery. The name is somewhat misleading - it does not necessarily mean the surgery itself failed or was done incorrectly. In many cases, the surgery accomplished its intended goal (such as removing a disc herniation), but the patient's pain persists because of other factors.
FBSS is unfortunately common. Studies estimate that 10 to 40% of patients who undergo lumbar spine surgery continue to have significant pain afterward. The condition can be frustrating for patients who expected surgery to resolve their pain, and it is one of the most common reasons patients are referred to interventional pain specialists.
Why Does Pain Persist After Spine Surgery?
There are many reasons pain can continue after spine surgery. In some cases, multiple factors contribute at the same time:
Epidural fibrosis (scar tissue): Surgery creates scar tissue in the epidural space that can irritate or compress nerve roots over time. This is one of the most common causes of persistent pain after laminectomy or discectomy.
Adjacent segment disease: After a spinal fusion, the levels above and below the fusion take on increased mechanical stress. Over time, these adjacent segments can develop disc herniations, stenosis, or arthritis.
Recurrent disc herniation: A new herniation can occur at the same level that was previously operated on.
Incomplete decompression: Residual nerve compression that was not fully addressed during surgery.
Facet joint pain: Surgery addresses disc and nerve pathology but does not treat the facet joints, which may become a separate pain source.
SI joint dysfunction: Lumbar fusion in particular can alter the biomechanics of the sacroiliac joints, causing new SI joint pain.
Nerve damage: In some cases, the nerve root was damaged before or during surgery and continues to generate pain signals.
Central sensitization: Chronic pain can change how the nervous system processes pain signals, making the pain persist even after the structural problem has been addressed.
How is FBSS Diagnosed?
Diagnosing the cause of pain after spine surgery requires careful evaluation. Dr. Carrera's team reviews your surgical records, pre-operative and post-operative imaging, and performs a detailed physical examination. Updated imaging (MRI with and without contrast, or CT) may be needed to look for scar tissue, recurrent herniations, hardware issues, or adjacent segment changes.
Diagnostic injections - such as selective nerve blocks, facet joint injections, medial branch blocks, or SI joint injections - are often used to identify which structure is generating the pain. This step-by-step diagnostic approach is critical because FBSS can involve multiple pain generators simultaneously.
How is FBSS Treated?
Treatment depends on what is causing the persistent pain. Dr. Carrera's team works through the possibilities systematically:
Caudal epidural steroid injections: For patients with scar tissue compressing nerves, the caudal approach enters the epidural space from the tailbone - below the surgical site - to avoid navigating through scar tissue. This is often the preferred epidural approach for post-surgical patients. More on the caudal epidural page.
Transforaminal epidural steroid injections: If a specific nerve root is being compressed by a recurrent herniation or adjacent segment disc, a targeted transforaminal epidural can deliver medication directly to that nerve. More on the TFESI page.
Facet joint treatments (MBB and RFA): If facet joints have become a pain source after surgery, medial branch blocks and radiofrequency ablation can provide months of relief. More on the medial branch block page and the RFA page.
SI joint injection and treatment: If the sacroiliac joint has become a pain generator after lumbar fusion, diagnostic and therapeutic SI joint injections can confirm the diagnosis and provide relief. SI joint radiofrequency ablation is available for longer-lasting results. More on the SI joint injection page.
Spinal cord stimulation (SCS): For patients with chronic nerve pain from FBSS that has not responded to injections and other treatments, spinal cord stimulation is one of the most effective options available. SCS uses a trial-first approach - you test the device for about 6 days before deciding whether to proceed with a permanent implant. FBSS is one of the best-studied and most successful indications for SCS. More on the spinal cord stimulator page.
Peripheral nerve stimulation (PNS): For localized post-surgical nerve pain, peripheral nerve stimulation may target the specific nerve causing symptoms. More on the PNS page.
Is More Surgery the Answer?
In some cases, revision surgery may be appropriate - particularly for hardware failure, clear recurrent disc herniations, or progressive instability. However, the success rate of revision spine surgery is generally lower than first-time surgery. Dr. Carrera's team focuses on non-surgical options and works closely with spine surgeons to determine whether additional surgery or interventional pain management is the better path for each patient.
For Referring Providers
FBSS is a complex condition that often involves multiple pain generators. Dr. Carrera's team uses a systematic diagnostic approach - selective nerve blocks, facet injections, SI joint injections, and imaging review - to identify treatable sources of pain. For post-surgical patients with persistent pain, fax the referral along with operative reports and recent imaging to 720-455-3776. The team handles scheduling, diagnostic workup, and insurance authorization. Call 720-455-3775 with questions about specific cases.
Patients in Castle Rock, Lone Tree, Parker, Highlands Ranch, Denver, Colorado Springs, and surrounding areas can call 720-455-3775 to schedule an evaluation.
Call 720-455-3775 to schedule an appointment