OBJECTIVES: Failed back surgery syndrome (FBSS) is defined as persistent back pain following spine surgery, particularly when the procedure fails to relieve pre-operative symptoms. To understand FBSS prevalence, we identified patient characteristics which may predict FBSS development.

METHODS: De-identified patient records were extracted from Cerner Real World Data, a US electronic health record database. Patients who underwent spine surgery between 2018-2019, and then those who developed FBSS, were identified via ICD-10 codes. The first procedure was used as the index. Diagnoses of depression or anxiety were assessed up to six months pre-index using ICD-10-CM, while age, body mass index (BMI), and sex were evaluated at index. Number of lifetime back surgeries prior to index was also evaluated. Univariate and bivariate analyses were conducted using logistic regression to report prevalence ratios (PR).

RESULTS: A total 22,020 patients underwent spine surgery, of whom 728 developed FBSS (median age 61 years; 55% female). Compared to patients aged 18-44, FBSS was more likely in age groups 45-54 and 55-64 by factors of 1.38 (p=0.023) and 1.33 (p=0.03), respectively. Those with a history of moderate depression were 1.50x (p=0.04) more likely to have FBSS compared to those with no depression history, while overweight and obese patients were 1.48x (p=0.017) and 1.92x (p<0.00001) more likely to have FBSS compared to patients with normal BMIs. Prior back surgeries were also linked to higher FBSS prevalence: 2 (PR: 1.22, p=0.025), 3 (PR: 1.43, p=0.0048), 4 (PR: 1.88, p<0.00001), and 5+ surgeries (PR: 2.36, p<0.00001). Bivariate analyses found that FBSS was more likely in females who were overweight, obese, and moderately depressed, by factors of 1.66 (p=0.0271), 2.25 (p=0.00006), and 1.81 (p=0.011), respectively.

CONCLUSIONS: A multitude of factors may contribute to FBSS onset, highlighting the need to weigh benefits against risks when considering surgical treatment for back pain relief.