Failed back surgery syndrome
The operation did what it was designed to do. That is compatible with the patient still being in pain, and the nomenclature has finally caught up.
Failed back surgery syndrome is being replaced by persistent spinal pain syndrome, a mechanism-based term that stops implying the surgeon failed. The change matters in litigation, because the old name imports a conclusion the medicine does not support.
Why the name changed
Thomson and colleagues describe the implementation of persistent spinal pain syndrome as a mechanism-based nomenclature. The older term embedded a judgment — that something failed — into what is usually a straightforward situation: a structural problem was corrected and a pain problem persisted, often because the pain generator was never the structure that was operated on.
For a case, the terminology matters. “Failed back surgery” invites an argument about the surgery. “Persistent spinal pain syndrome” keeps the focus on what is generating pain now.
What is usually going on
- A generator that was never identified before the operation, still present afterwards — frequently facet or sacroiliac.
- Adjacent segment loading after fusion.
- Neuropathic pain from a root injured before or during surgery.
- Central sensitization established during the months or years of pain before the operation — see central sensitization.
- A metabolic terrain that prevents resolution regardless of the mechanics — see metabolic dysfunction and injury.
In a case
The argument will be made that the surgery, not the collision, explains the current state. The response is to identify what is generating pain now and when it started, which is diagnostic work rather than argument — see diagnostic nerve blocks.
We do not offer opinions on whether the surgery was indicated or well performed. This practice is not aligned to a side. Its obligation runs to the patient’s health and safety, which is the same reason it is not beholden to any position that would keep it from seeing what is actually there. We do not offer opinions on liability, we do not accept a referral or a review conditioned on reaching a particular conclusion, and we will say plainly when the evidence does not support the claim — whichever party was hoping otherwise.
Common questions
Does persistent pain mean the surgery was wrong?
No. It usually means the pain generator was not the structure the surgery addressed.
Which term should the record use?
Persistent spinal pain syndrome, with the older term noted where prior records use it, so the two can be matched.
Can the generator still be found afterwards?
Often, yes. Facet and sacroiliac sources are commonly identifiable by block after a fusion.
Will you comment on the surgeon’s decision?
No. This practice does not offer standard-of-care opinions about other clinicians.
Related reading
- Lumbar disc injury
- Diagnostic nerve blocks
- Central sensitization
- Sacroiliac joint injury
- Future care and life-care plans
Ask what is generating the pain now
That question is answerable after surgery as often as before it.
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Sources
- Thomson S et al. The implementation of persistent spinal pain syndrome (PSPS): mechanism-based nomenclature. Pain Practice, 2026. PubMed 41222498
- Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Regional Anesthesia and Pain Medicine, 2020. PubMed 32245841
- Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain, 2011. PubMed 20961685
- Okifuji A, Hare BD. The association between chronic pain and obesity. Journal of Pain Research, 2015. PubMed 26203274