Skip to main content
Download PDF

Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease

BMC Musculoskeletal Disorders volume 23, Article number: 1141 (2022) Cite this article

Abstract

Background

With the growing number of traditional posterior open surgery, the incidence of failed back surgery syndrome (FBSS) increases gradually. We aimed to investigate the incidence and risk factors for FBSS following open posterior lumbar surgery for degenerative lumbar disease (DLD).

Method

A multivariable regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed.

Result

16.8% of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariable logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71–0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10–4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75–9.47, P = 0.001) and waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54–27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00–17.04, P < 0.001), MCs (OR: 3.41, 95%CI: 1.73–6.71, P < 0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13–6.12, P = 0.024) were risk factors for FBSS.

Conclusion

Open posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.

Peer Review reports

Background

In the past three decades, low back pain (LBP) has been the main cause of non-fatal health loss, and the resulting burden poses a severe challenge to the coping ability of health care systems in various countries [1]. Degenerative lumbar disease (DLD) is the main cause of LBP, whose prevalence is positively correlated with the increase of age. With the aggravation of population aging, more and more attention has been paid to this very disease [2, 3].

Traditional posterior open surgery is a classic and effective surgical method for DLD. Nonetheless, as the sophistication of lumbar surgery technology and the increasing number of its implementation, more and more researchers have realized that although the structural deficits of the initial operation have been excluded, postoperative persistent pain and/or numbness in the back or legs still afflict the patients, which results in their dissatisfaction. On the other hand, some patients are still not satisfied even though they have achieved clinical improvement in disability or pain [4].

Failed back Surgery syndrome (FBSS) is a term used to describe patients' dissatisfaction with the effect of lumbar surgery [5]. Over the 40 years since this concept was proposed, the definition of FBSS has been gradually diluted and generalized. A large number of terms have emerged to describe the same condition [6, 7], which has derived heterogeneous diagnostic criteria. (Table 1).

Table 1 A summary of diagnostic criteria and characteristics of FBSS
Full size table

A large number of studies have been conducted on the risk factors of FBSS, and psychiatric disorders such as depression and insomnia have been proved to be associated with FBSS [15, 16]. To the best of our knowledge, however, there is no research on the relationship between FBSS and the inherent characteristics of DLD, including but not limited to symptoms distribution, degree of intermittent claudication, radiographic parameters and more. It is also unclear whether postoperative rehabilitation affects the incidence of FBSS.

Here, in order to explore the risk factors of FBSS after traditional posterior open surgery, we put forward a more comprehensive diagnostic criterion built on the existing literature and conducted a retrospective study based on prospectively collected data. We hope that this study will increase clinicians' understanding of FBSS and have a positive impact on its management.

Methods

Study design and participants

This was a retrospective review of prospectively collected data which incorporated DLD patients who underwent traditional posterior open surgery between January 2018 and August 2020 with a minimum of 3-month follow-up at a single institution. Traditional posterior open surgery, which refers to fenestration discectomy (FD), posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) was performed by 6 senior spine surgeons in our institution. As for the surgical procedures, briefly, all patients were positioned prone under general anesthesia. After the exposure of the spinous processes, laminae, and transverse processes, pedicle screw instrumentation and posterior decompression were carried out for PLF and PLIF groups. In the PLF group, autologous bone from the spinous process and laminae was placed on decorticated transverse processes and facet joints bilaterally. In the PLIF group, the cage with autogenous bone was implanted into the intervertebral space after a discectomy and endplate decortication. For FD, posterior decompression was performed after the removal of the lower edge of the upper laminae.

The inclusion criteria were: (1) the patients were older than 18 years; (2) the diagnosis of DLD, including lumbar disc herniation (LDH), lumbar spinal stenosis (LSS), degenerative spondylolisthesis (Meyerding I-II) was confirmed by X-ray photographs, computer tomography (CT) and magnetic resonance imaging (MRI). (3) all patients met the surgical indication of DLD. Patients who met the following criteria were excluded: (1) definite iatrogenic injury; (2) severe or progressive psychotic disorders; (3) an active workman’s compensation claim or medical disputes; (4) lumbar surgical history; (5) presence of trauma, neoplasm, infection, congenital deformations.

Here, a more quantitative and systematic definition of FBSS was developed as follows: An intractable pain or sensory deficits of low back and/or limbs postoperatively that have remained refractory to conservative treatment (> 3 months), which led to a dissatisfaction with the outcome of the surgery [17]. As for satisfaction, this research adopted the related questions in the validated North American Spine Society (NASS) questionnaire [18] in the form of telephone follow-up to evaluate.

Clinical and radiological outcomes

The following data were collected preoperatively: age, gender, diagnosis, chronic comorbidity such as hypertension and diabetes mellitus. The location of symptoms (low back pain without lower extremity symptoms, unilateral or bilateral lower extremity symptoms), duration of symptoms, concomitant intermittent claudication (IC), history of exacerbation, history of long-term analgesic use (≥ 6 months), preoperative and postoperative Numerical Rating Scale (NRS)-back and NRS-leg were also analyzed in this study. NRS is an assessment instrument on a scale ranging from 0 to 10, where 0 represented “no pain” and 10 represented “extreme pain”.

The following two categorized parameters were also analyzed. Surgical data: surgical strategy, surgical segment, operation duration and postoperative rehabilitation. Postoperative rehabilitation refers to the treatment under the guidance of physiotherapist rather than self-management. Radiographic outcomes: high intensity zone (HIZ) and Modic changes (MCs) in MRI. Lumbar lordosis (the Cobb angle between L1 vertebral superior endplate and S1 vertebral superior endplate) and segmental lordosis (the Cobb angle between the superior endplate of the superior vertebra and the inferior endplate of the inferior vertebra) (Fig. 1) [53] were measured at pre-operation and immediate post-operation [19]. To avoid bias, all information was collected by a study personnel unrelated to the operation.

Fig. 1
figure 1

The measurement of lumbar lordosis and segmental lordosis at pre-operation and immediate post-operation

Full size image

Statistics

Continuous data are expressed as mean ± standard deviation and categorical data are given as frequency and/or percentage. Independent or paired sample t-test was performed on the data subject to normal distribution, for those who don’t obey normal distribution, Mann–Whitney U test was conducted. Categorical data between two groups were analyzed using the Fisher exact test or chi-squared test, as appropriate. Covariate selection for the multivariable analysis (backward elimination, conditional) was based on P < 0.05 in univariate analysis. SPSS version 26.0 software (IBM Corporation, USA) was used to analyze the data. P < 0.05 was considered as being statistically significant.

Results

A total of 333 patients were enrolled in this study. All clinical outcome scores and radiographic parameters were significantly improved postoperatively (P < 0.001). (Table 2) 56 patients meeting the inclusion criteria were regarded as the FBSS + group with an incidence rate of 16.8%, whose mean follow-up time was 24.4 ± 6.8 months. The counterpart was 22.4 ± 6.9 months in FBSS- group. The final follow-up rate was 92% and 95% respectively. Reasons of dissatisfaction were revealed through further follow-up: 40 people suffered from persistent postoperative pain, 9 people afflicted by unrelieved or even aggravated numbness, 2 people due to no improvement in lower extremity muscle strength. 2 patients with pain and numbness at the same time and 3 patients with pain accompanied by lower limb weakness.

Table 2 Clinical outcome and radiographic parameters
Full size table

Demographics of the patients was shown in Table 3. The mean age of FBSS + group and FBSS- group was 60.6 years and 53.8 years respectfully. Patients with hypertension accounted for 64.7% in FBSS + group, the counterpart was 22.6% in FBSS- group. Univariate analysis showed that the age of patients suffered from FBSS was significantly older than those who didn’t (P < 0.05). The comorbidity of hypertension in the FBSS + group was more common than that in the FBSS- group (P < 0.05). There was no significant difference in gender, diabetes mellitus and diagnosis between the two groups.

Table 3 Demographics
Full size table

Table 4 presented diagnostic characteristics of patients. Univariate analysis illustrated that the distribution of lower extremity symptoms might be related to the occurrence of FBSS. Patients without IC were less likely to develop FBSS (17.3% vs 60.7%, P < 0.05). Compared with the FBSS- group, the preoperative NRS-leg was significantly lower in patients with FBSS (6.3 ± 2.7 vs 7.3 ± 2.2, P < 0.05).

Table 4 Diagnostic characteristics
Full size table

Comparison of the FBSS incidence among different surgical techniques showed significant differences. Postoperative rehabilitation may have an effect on the incidence of FBSS (P < 0.05) as shown in Table 5. Table 6 showed that HIZ and MCs on MRI were more prevalent in the FBSS + group than those in the FBSS- group.

Table 5 Surgical data
Full size table
Table 6 Radiographic parameters
Full size table

Results of the multivariable logistic regression analysis are shown in Fig. 2. A lower preoperative NRS-leg (OR:0.80, 95%CI:0.71–0.91, P = 0.001), hypertension (OR: 2.22, 95%CI: 1.10–4.51, P = 0.027), intermittent claudication with waking distance > 100 m (OR: 4.07, 95%CI: 1.75–9.47, P = 0.001), intermittent claudication with waking distance ≤ 100 m (OR: 12.43, 95%CI: 5.54–27.92, P < 0.001), HIZ (OR: 8.26, 95%CI: 4.00–17.04, P < 0.001) and MCs (OR: 3.41, 95%CI: 1.73–6.71, P < 0.001) on MRI, postoperative rehabilitation (OR: 2.63, 95%CI: 1.13–6.12, P = 0.024) were the independent risk factors of FBSS.

Fig. 2
figure 2

Multivariable logistic regression analysis: independent risk factors of FBSS

Full size image

Discussion

Failed back surgery syndrome (FBSS) was controversial since it was proposed in the 1970s because of its various definitions and diagnostic criteria [20, 21].The definition of ‘dissatisfaction’ and ‘persistent pain’ was equated simplistically and misused. In fact, patients with optimistic expectations for surgery had higher degree of satisfaction in despite of similar postoperative pain scores [22], which highlighted the necessity of our modification. The present study introduced a quantitative satisfaction evaluation in order to standardize the definition of FBSS.

The prevalence of FBSS ranges from 10 to 40% according to different researches [12, 23]. Persistent pain, frequent hospitalization and the resulting heavy financial burden will not only aggravate the doctor-patient contradictions, but also lead to an excessive occupation of medical resources [24]. Unfortunately, most of the existing studies focused on the psychological factors of patients, while ignoring the inherent characteristics of DLD [15, 16, 21]. This research, on the other hand, based on the comprehensive analysis of disease characteristics, identified a series of independent risk factors of FBSS in order to arouse the vigilance of clinicians and patients, so as to manage high-risk population effectively and promptly. Surgeries performed by six different senior spine surgeons improved the external validity of our outcomes.

Studies conducted in different medical centers have proved that hypertension has an adverse effect on chronic pain [25, 26]. What’s more, the intake of antihypertensive agents may increase pain sensitivity[27]. Hypertension is significantly associated with postoperative dissatisfaction for adult spinal deformities according to a multicenter retrospective study [28]. We speculate that this effect may be related to hypertension-mediated sympathetic nervous system dysfunction, which leads to a significant rise in neurological complications following operation [29]. At the same time, chronic pain caused by DLD plays an important role in blood pressure regulation by compromising activity in the descending pathways originating in brainstem regions that exert inhibitory influences on spinal neuronal function. The dysregulation of descending inhibition reduces the sensitivity of baroreceptors, which result in the impairment of cardiovascular regulation function with a concomitant increase in blood pressure. A vicious circle of ‘pain-hypertension-pain’ was formed eventually [30,31,32].

The current study confirms the negative effect of IC on spinal surgery. Based on five-year follow-up, a retrospective study noted that walking distance was significantly correlated with postoperative satisfaction of patients with DLD [33]. Sigmundsson et al. [34] analyzed 5100 patients collected prospectively and found that the rate of satisfaction reported by patients with walking distance > 1000 m was 2.4 times higher than that of patients with walking distance < 100 m. Similarly, a prospective study [35]reported that the risk of postoperative dissatisfaction could be increased by 10.3 times under the condition of walking difficulty who also showed a significant correlation with symptoms that may bring about FBSS, such as postoperative back pain, leg pain and numbness.

In the context of the rampant pandemic, NRS, whose reliability had been fully corroborated, is favored by clinicians due to its comprehensibility and higher compliance [36]. A retrospective cohort study [18] indicated that preoperative NRS leg pain was the only predictor of patient satisfaction following TLIF, which is analogous to our conclusion: for every 1-point increase in preoperative NRS-leg, the risk of FBSS is reduced by 20%. On the one hand, the operation leads to greater improvement in patients afflicted to more severe limb pain and result in increased satisfaction [37]. On the other hand, patients with lower NRS leg pain have more complicated operation willingness than those with higher NRS because of relatively mild neurologic symptoms. When patients with prolonged illness have to resort to surgery, whom they tended to regard as ‘the final solution’, holding too high or even unrealistic expectations that fully restore to health or return to work immediate postoperatively would finally result in dissatisfaction, even if the operation did improve neurological function to some extent.

HIZ and MCs, the reliable biomarkers of persistent pain, play an important role in the course of DLD by inducing inflammatory response [38, 39]. Preoperative MCs suggests poor clinical improvement and slow recovery [40], while HIZ indicates severe disc degeneration/displacement and the resulting severe, prolonged low back pain [41]. In addition, there were 5/12 HIZ and 8/25 MCs located outside the surgical segment, despite the lack of statistical significance, this might be another reason for refractory or even aggravated pain/numbness and consequent dissatisfaction of FBSS patients.

Contrary to a general impression, our result confirms that admission for rehabilitation treatment is a risk factor for FBSS. In this study, only 44 people were hospitalized for rehabilitation postoperatively, accounting for 13.2% of the total. Most of patients said it was out of economic considerations, while others were skeptical of the treatment itself. Despite a lot of research, there is no definite conclusion about mode and timing of postoperative rehabilitation, and even the necessity of hospitalization for it [42, 43]. In fact, a number of RCTs and systematic reviews had pointed out the limited benefits of rehabilitation relative to self-management in terms of improving of pain, walking ability, return to work, working ability, satisfaction and amelioration of poor surgical results [42, 44,45,46]. A similar effect of rehabilitation and sham treatment suggests that psychologic factors have a substantial effect on efficacy assessment [47]. In this case, the behavior of being hospitalized for further treatment implies the dissatisfaction with the effect of surgery, which can be further deepened with the extension of hospital stay and the increase of cost.

There are several limitations in this study. First, a relatively short follow-up time may mask changes in outcome indicators due to other degeneration in long-term follow-up. From another perspective, it enables us to rule out new symptoms caused by deterioration of the degeneration and use the above risk factors to identify risk groups efficiently. Besides, the conclusions derived from this single-center, retrospective study still needs to be verified by high-quality RCTs with a rigorous standard of diagnosis. Even so, we believe these risk factors can provide theoretical support for medical providers and encourage them to pay more attention to the management of high-risk groups.

Conclusions

Open posterior lumbar surgery is an effective treatment for DLD which provides pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, which can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradictions and further occupation of medical resources.

Availability of data and materials

To avoid privacy being damaged from the research participants, the data will not be disclosed. Requests for data without being shown in this manuscript can be made to the corresponding author.

Abbreviations

CT:

Computer tomography

DLD:

Degenerative lumbar disease

FBSS:

Failed back surgery syndrome

FD:

Fenestration discectomy

HIZ:

High intensity zone

IC:

Intermittent claudication

LBP:

Low back pain

LDH:

Lumbar disc herniation

LSS:

Lumbar spinal stenosis

MCs:

Modic changes

MRI:

Magnetic resonance imaging

NRS:

Numerical rating scale

NASS:

North American Spine Society

PLIF:

Posterior lumbar interbody fusion

PLF:

Posterolateral fusion

RCT:

Randomized controlled trial

References

  1. Disease GBD, Injury I, Prevalence C. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–858. https://doi.org/10.1016/S0140-6736(18)32279-7.

    Article  Google Scholar 

  2. Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H, Aman Y, Frank J, Liao J, Zou H, Wang NY, Wu J, Liu X, Li T, Fang Y, Niu Z, Yang G, Hong J, Wang Q, Chen G, Li J, Chen HZ, Kang L, Su H, Gilmour BC, Zhu X, Jiang H, He N, Tao J, Leng SX, Tong T, Woo J. A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev. 2020;64:101174.

    Article  Google Scholar 

  3. Ho CN, Liao JC, Chen WJ. Instrumented Posterolateral fusion versus instrumented Interbody fusion for degenerative lumbar diseases in uremic patients under hemodialysis. BMC Musculoskelet Disord. 2020;21:815. https://doi.org/10.1186/s12891-020-03815-z.

    Article  Google Scholar 

  4. Sivaganesan A, Khan I, Pennings JS, Roth SG, Nolan ER, Oleisky ER, Asher AL, Bydon M, Devin CJ, Archer KR. Why are patients dissatisfied after spine surgery when improvements in disability and pain are clinically meaningful? Spine J. 2020;20:1535–43. https://doi.org/10.1016/j.spinee.2020.06.008.

    Article  Google Scholar 

  5. Bordoni B, Marelli F. Failed back surgery syndrome: review and new hypotheses. J Pain Res. 2016;9:17–22. https://doi.org/10.2147/JPR.S96754.

    Article  Google Scholar 

  6. Chan CW, Peng P. Failed back surgery syndrome. Pain Med. 2011;12:577–606. https://doi.org/10.1111/j.1526-4637.2011.01089.x.

    Article  Google Scholar 

  7. Rigoard P, Desai MJ, Taylor RS. Failed back surgery syndrome: what’s in a name? a proposal to replace “FBSS” by “POPS.” Neurochirurgie. 2015;61(Suppl 1):S16-21. https://doi.org/10.1016/j.neuchi.2014.12.001.

    Article  Google Scholar 

  8. Merskey H, Bogduk N. Lumbar spinal or radicular pain after failed spinal surgery. Classification of Chronic Pain Seattle. 1994.

    Google Scholar 

  9. Leveque JC, Villavicencio AT, Bulsara KR, Rubin L, Gorecki JP. Spinal cord stimulation for failed back surgery syndrome. Neuromodulation. 2001;4:1–9. https://doi.org/10.1046/j.1525-1403.2001.00001.x.

    Article  Google Scholar 

  10. Waguespack A, Schofferman J, Slosar P, Reynolds J. Etiology of long-term failures of lumbar spine surgery. Pain Med. 2002;3:18–22. https://doi.org/10.1046/j.1526-4637.2002.02007.x.

    Article  Google Scholar 

  11. Kumar K, North R, Taylor R, Sculpher M, Van den Abeele C, Gehring M, Jacques L, Eldabe S, Meglio M, Molet J, Thomson S, O’Callaghan J, Eisenberg E, Milbouw G, Fortini G, Richardson J, Buchser E, Tracey S, Reny P, Brookes M, Sabene S, Cano P, Banks C, Pengelly L, Adler R, Leruth S, Kelly C, Jacobs M. Spinal cord stimulation vs. conventional medical management: a prospective, randomized, controlled, multicenter study of patients with failed back surgery syndrome (PROCESS Study). Neuromodulation. 2005;8:213–8. https://doi.org/10.1111/j.1525-1403.2005.00027.x.

    Article  Google Scholar 

  12. Bokov A, Isrelov A, Skorodumov A, Aleynik A, Simonov A, Mlyavykh S. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician. 2011;14:545–57.

    Article  Google Scholar 

  13. De Andres J, Monsalve-Dolz V, Fabregat-Cid G, Villanueva-Perez V, Harutyunyan A, Asensio-Samper JM, Sanchis-Lopez N. Prospective, randomized blind effect-on-outcome study of conventional vs high-frequency spinal cord stimulation in patients with pain and disability due to failed back surgery syndrome. Pain Med. 2017;18:2401–21. https://doi.org/10.1093/pm/pnx241.

    Article  Google Scholar 

  14. Cho JH, Lee JH, Song KS, Hong JY, Joo YS, Lee DH, Hwang CJ, Lee CS. Treatment outcomes for patients with failed back surgery. Pain Physician. 2017;20:E29–43.

    Article  Google Scholar 

  15. Schoell K, Wang C, D’Oro A, Heindel P, Lee L, Wang JC, Buser Z. Depression increases the rates of neurological complications and failed back surgery syndrome in patients undergoing lumbar spine surgery. Clin Spine Surg. 2019;32:E78–85. https://doi.org/10.1097/BSD.0000000000000730.

    Article  Google Scholar 

  16. Yun SY, Kim DH, Do HY, Kim SH. Clinical insomnia and associated factors in failed back surgery syndrome: a retrospective cross-sectional study. Int J Med Sci. 2017;14:536–42. https://doi.org/10.7150/ijms.18926.

    Article  Google Scholar 

  17. Ma K, Zhuang ZG, Wang L, Liu XG, Lu LJ, Yang XQ, Lu Y, Fu ZJ, Song T, Huang D, Liu H, Huang YQ, Peng BG, Liu YQ. The Chinese Association for the Study of Pain (CASP): consensus on the assessment and management of chronic nonspecific low back pain. Pain Res Manag. 2019;2019:8957847. https://doi.org/10.1155/2019/8957847.

    Article  Google Scholar 

  18. Lim JBT, Yeo W, Chen JLT. Preoperative leg pain score predicts patient satisfaction after transforaminal lumbar interbody fusion surgery. Global Spine J. 2018;8:354–8. https://doi.org/10.1177/2192568217723888.

    Article  Google Scholar 

  19. Zhu HF, Wang GL, Zhou ZJ, Fan SW. Prospective study of long-term effect between multifidus muscle bundle and conventional open approach in one-level posterior lumbar interbody fusion. Orthop Surg. 2018;10:296–305. https://doi.org/10.1111/os.12402.

    Article  Google Scholar 

  20. Rodrigues FF, Dozza DC, de Oliveira CR, de Castro RG. Failed back surgery syndrome: casuistic and etiology. Arq Neuropsiquiatr. 2006;64:757–61. https://doi.org/10.1590/s0004-282x2006000500011.

    Article  Google Scholar 

  21. Sebaaly A, Lahoud MJ, Rizkallah M, Kreichati G, Kharrat K. Etiology, evaluation, and treatment of failed back surgery syndrome. Asian Spine J. 2018;12:574–85. https://doi.org/10.4184/asj.2018.12.3.574.

    Article  Google Scholar 

  22. Carr FA, Healy KM, Villavicencio AT, Nelson EL, Mason A, Burneikiene S, Hernandez TD. Effect on clinical outcomes of patient pain expectancies and preoperative mental component summary scores from the 36-item short form health survey following anterior cervical discectomy and fusion. J Neurosurg Spine. 2011;15:486–90. https://doi.org/10.3171/2011.6.SPINE11114.

    Article  Google Scholar 

  23. Stromqvist B, Fritzell P, Hagg O, Jonsson B, Sanden B, Swedish Society of Spinal S. Swespine: the Swedish spine register : the 2012 report. Eur Spine J. 2013;22:953–74. https://doi.org/10.1007/s00586-013-2758-9.

    Article  Google Scholar 

  24. Kim LH, Vail D, Azad TD, Bentley JP, Zhang Y, Ho AL, Fatemi P, Feng A, Varshneya K, Desai M, Veeravagu A, Ratliff JK. Expenditures and health care utilization among adults with newly diagnosed low back and lower extremity pain. JAMA Netw Open. 2019;2: e193676. https://doi.org/10.1001/jamanetworkopen.2019.3676.

    Article  Google Scholar 

  25. Desai G, TS J, GR G, Bajaj A, Chaturvedi SK. Disentangling comorbidity in chronic pain: a study in primary health care settings from India. Plos one. 2020;15(11):e0242865.https://doi.org/10.1371/journal.pone.0242865

  26. Alhowimel AS, Alodaibi F, Alshehri MM, Alqahtani BA, Alotaibi M, Alenazi AM. Prevalence and risk factors associated with low back pain in the saudi adult community: a cross-sectional study. Int J Environ Res Public Health. 2021;18(24):13288. https://doi.org/10.3390/ijerph182413288.

    Article  Google Scholar 

  27. Guasti L, Zanotta D, Diolisi A, Garganico D, Simoni C, Gaudio G, Grandi AM, Venco A. Changes in pain perception during treatment with angiotensin converting enzyme-inhibitors and angiotensin II type 1 receptor blockade. J Hypertens. 2002;20:485–91. https://doi.org/10.1097/00004872-200203000-00024.

    Article  CAS  Google Scholar 

  28. Bakhsheshian J, Scheer JK, Gum JL, Hostin R, Lafage V, Bess S, Protopsaltis TS, Burton DC, Keefe MK, Hart RA, Mundis GM Jr, Shaffrey CI, Schwab F, Smith JS, Ames CP, International Spine Study G. Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up. J Neurosurg Spine. 2017;26:116–24. https://doi.org/10.3171/2016.5.SPINE151428.

    Article  Google Scholar 

  29. Scalco AZ, Scalco MZ, Azul JB, Lotufo Neto F. Hypertension and depression. Clinics (Sao Paulo). 2005;60:241–50. https://doi.org/10.1590/s1807-59322005000300010.

    Article  Google Scholar 

  30. Bruehl S, Olsen RB, Tronstad C, Sevre K, Burns JW, Schirmer H, Nielsen CS, Stubhaug A, Rosseland LA. Chronic pain-related changes in cardiovascular regulation and impact on comorbid hypertension in a general population: the Tromso study. Pain. 2018;159:119–27. https://doi.org/10.1097/j.pain.0000000000001070.

    Article  Google Scholar 

  31. Fayaz A, Ayis S, Panesar SS, Langford RM, Donaldson LJ. Assessing the relationship between chronic pain and cardiovascular disease: a systematic review and meta-analysis. Scand J Pain. 2016;13:76–90. https://doi.org/10.1016/j.sjpain.2016.06.005.

    Article  Google Scholar 

  32. Sacco M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, Pioli S, Magnano A, Spagnoli F, Giuri PG, Fiaccadori E, Caiazza A. The relationship between blood pressure and pain. J Clin Hypertens (Greenwich). 2013;15:600–5. https://doi.org/10.1111/jch.12145.

    Article  Google Scholar 

  33. Bouras T, Zairi F, Loufardaki M, Triffaux M, Stranjalis G. Which functional outcome parameters correlate better with elderly patients’ satisfaction after non-fusion lumbar spine surgery? J Neurosurg Sci. 2019;63:365–71. https://doi.org/10.23736/S0390-5616.17.03977-7.

    Article  Google Scholar 

  34. Sigmundsson FG, Jonsson B, Stromqvist B. Determinants of patient satisfaction after surgery for central spinal stenosis without concomitant spondylolisthesis: a register study of 5100 patients. Eur Spine J. 2017;26:473–80. https://doi.org/10.1007/s00586-016-4495-3.

    Article  Google Scholar 

  35. Yamashita K, Hayashi J, Ohzono K, Hiroshima K. Correlation of patient satisfaction with symptom severity and walking ability after surgical treatment for degenerative lumbar spinal stenosis. Spine  (Phila Pa 1976). 2003;28:2477–81. https://doi.org/10.1097/01.BRS.0000090888.63860.4F.

    Article  Google Scholar 

  36. Chaudhry H, Nadeem S, Mundi R. How satisfied are patients and surgeons with telemedicine in orthopaedic care during the COVID-19 Pandemic? a systematic review and meta-analysis. Clin Orthop Relat Res. 2021;479:47–56. https://doi.org/10.1097/CORR.0000000000001494.

    Article  Google Scholar 

  37. Ogura Y, Kobayashi Y, Shinozaki Y, Kitagawa T, Yonezawa Y, Takahashi Y, Yoshida K, Yasuda A, Ogawa J. Factors influencing patient satisfaction after decompression surgery without fusion for lumbar spinal stenosis. Global Spine J. 2020;10:627–32. https://doi.org/10.1177/2192568219868205.

    Article  Google Scholar 

  38. Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes - an evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma. 2020;11:761–9. https://doi.org/10.1016/j.jcot.2020.06.025.

    Article  Google Scholar 

  39. Liu W, Liu D, Zheng J, Shi P, Chou PH, Oh C, Chen D, An HS, Chee A. Annulus fibrosus cells express and utilize C-C chemokine receptor 5 (CCR5) for migration. Spine J. 2017;17:720–6. https://doi.org/10.1016/j.spinee.2017.01.010.

    Article  Google Scholar 

  40. Schistad EI, Espeland A, Rygh LJ, Roe C, Gjerstad J. The association between Modic changes and pain during 1-year follow-up in patients with lumbar radicular pain. Skeletal Radiol. 2014;43:1271–9. https://doi.org/10.1007/s00256-014-1928-0.

    Article  Google Scholar 

  41. Teraguchi M, Cheung JPY, Karppinen J, Bow C, Hashizume H, Luk KDK, Cheung KMC, Samartzis D. Lumbar high-intensity zones on MRI: imaging biomarkers for severe, prolonged low back pain and sciatica in a population-based cohort. Spine J. 2020;20:1025–34. https://doi.org/10.1016/j.spinee.2020.02.015.

    Article  Google Scholar 

  42. Aalto TJ, Leinonen V, Herno A, Alen M, Kroger H, Turunen V, Savolainen S, Saari T, Airaksinen O. Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up. Eur Spine J. 2011;20:1331–40. https://doi.org/10.1007/s00586-011-1781-y.

    Article  Google Scholar 

  43. Kernc D, Strojnik V, Vengust R. Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial. J Orthop Surg Res. 2018;13:151. https://doi.org/10.1186/s13018-018-0853-7.

    Article  Google Scholar 

  44. Mannion AF, Denzler R, Dvorak J, Muntener M, Grob D. A randomised controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. Eur Spine J. 2007;16:1101–17. https://doi.org/10.1007/s00586-007-0399-6.

    Article  Google Scholar 

  45. Oosterhuis T, Costa LO, Maher CG, de Vet HC, van Tulder MW, Ostelo RW. Rehabilitation after lumbar disc surgery. Cochrane Database Syst Rev. 2014:CD003007. https://doi.org/10.1002/14651858.CD003007.pub3

  46. Paulsen RT, Rasmussen J, Carreon LY, Andersen MO. Return to work after surgery for lumbar disc herniation, secondary analyses from a randomized controlled trial comparing supervised rehabilitation versus home exercises. Spine J. 2020;20:41–7. https://doi.org/10.1016/j.spinee.2019.09.019.

    Article  Google Scholar 

  47. Erdogmus CB, Resch KL, Sabitzer R, Muller H, Nuhr M, Schoggl A, Posch M, Osterode W, Ungersbock K, Ebenbichler GR. Physiotherapy-based rehabilitation following disc herniation operation: results of a randomized clinical trial. Spine (Phila Pa 1976). 2007;32:2041–9. https://doi.org/10.1097/BRS.0b013e318145a386.

    Article  Google Scholar 

Download references

Acknowledgements

The authors appreciate all the assistance and cooperation from the doctors and nurses of China-Japan Union Hospital of Jilin University.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Departments of Orthopedics, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, 130033, Jilin, P.R. China

    Wenbo Xu, Jianhui Zhao, Wenqi Luo & Rui Gu

  2. Departments of Medical Cosmetology, Jilin Province People’s Hospital, No. 1183, Gongnong Road, Changchun, 130021, Jilin, P.R. China

    Bingbing Ran

Authors
  1. Wenbo Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bingbing Ran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jianhui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenqi Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rui Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

W.X. and R.G. conceived and designed the study. W.X., B.R. analyzed the data and wrote the manuscript. J.Z., W.L. followed up the patients and collected the data. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Rui Gu.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the ethics committee of China-Japan Union Hospital of Jilin University (20220628022) and was therefore performed in accordance with ethical standards. All patients provided their informed consent prior to inclusion in the study.

Consent for publication

All the authors listed have agreed to the submission of this paper.

Competing interests

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xu, W., Ran, B., Zhao, J. et al. Risk factors for failed back surgery syndrome following open posterior lumbar surgery for degenerative lumbar disease. BMC Musculoskelet Disord 23, 1141 (2022). https://doi.org/10.1186/s12891-022-06066-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-022-06066-2

Keywords

  • Failed back surgery syndrome
  • Degenerative lumbar disease
  • Patient satisfaction
  • Risk factors
  • Lumbar spine surgery

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us