FBSS is not uniformly classified, but the symptoms can be distinguished by their cause and the time of occurrence:

• Persistent pain: Pain that continues immediately after the surgery and indicates an insufficient elimination of the original cause of pain.

• Recurrent pain: Pain that reappears after a symptom-free period, possibly due to scar formation or renewed disc problems.

• Newly occurring pain: Pain that arises in new areas and is due to complications or changes as a result of the surgery.

The development of FBSS can be attributed to various factors:

- Incomplete decompression: If not all causal structures were relieved during the operation, pain may persist.

- Scar formation (epidural fibrosis): Postoperative scarring can compress nerve roots and cause pain.

- Instability of the spine: The removal of disc material or bony structures can lead to instability, causing pain.

- Misdiagnosis: If the original cause of pain was not correctly identified, the surgery may be ineffective.

- Psychosocial factors: Depression, anxiety, or unrealistic expectations of the surgery can influence pain perception.

The symptoms vary depending on the cause and may include:

- Chronic back pain: Persistent pain in the operated area.

- Leg pain (sciatica): Pain radiating into the legs, similar to before the surgery.

- Neurological deficits: Numbness, tingling, or muscle weakness in the extremities.

- Limited mobility: Difficulties with everyday movements due to pain or stiffness.

The diagnosis requires a careful evaluation:

• Medical history: Detailed collection of pain history, surgical reports, and previous therapies.

• Clinical examination: Assessment of mobility, pain points, and neurological functions.

• Imaging techniques:

  • MRI (Magnetic Resonance Imaging): For assessing soft tissues, scar tissue, and intervertebral discs.

  • CT (Computed Tomography): For detailed bony structures and possible instabilities.

  • Electrophysiological tests: For evaluating nerve conductivity and identifying neurological impairments. 

The therapy of FBSS requires a multidisciplinary approach:

Conservative therapy:

Physiotherapy: To strengthen muscles, improve mobility, and reduce pain.

Medication treatment: Use of painkillers, antidepressants, or anticonvulsants for pain modulation.

Psychotherapy: Treatment of psychosocial factors that influence pain.

Interventional procedures:

Epidural injections: Administration of steroids to reduce inflammation and pain.

Nerve blocks: For targeted pain relief in affected areas.

Spinal Cord Stimulation (SCS): Implantation of a device that sends electrical impulses to modulate pain signals.

Surgical revision: In selected cases, a repeat surgery to correct anatomical problems may be considered.

To minimize the risk of FBSS, the following aspects should be considered:

• Careful patient selection: Thorough diagnostics and consideration of whether surgery is truly indicated.

• Education: Realistic presentation of the chances of success and possible risks of surgery.

• Optimization of conservative therapies: Exhaustion of non-surgical treatment options before surgery.

• Postoperative rehabilitation: Individually tailored rehabilitation program to promote recovery and avoid complications.