A PROSPECTIVE COHORT ANALYSIS OF INCIDENCE AND RISK FACTORS CONTRIBUTING TO FAILED BACK SURGERY SYNDROME (FBSS)

Abstract

Background: Failed Back Surgery Syndrome (FBSS) represents a complex postoperative condition characterized by persistent or recurrent lumbar pain following spinal surgery. Despite advancements in surgical techniques, FBSS remains a significant cause of disability, psychological burden, and repeated healthcare utilization. Degenerative Lumbar Disease (DLD) is one of the leading indications for spinal surgery, and the identification of pre- and postoperative risk factors remains essential in predicting and preventing surgical failure. Objective: To determine the incidence, associated demographic, clinical, psychosocial, and surgical risk factors contributing to FBSS among patients undergoing surgery for DLD at Jinnah Postgraduate Medical Centre (JPMC). Methods: This prospective cohort study enrolled 220 adult patients undergoing lumbar spine surgery for DLD. Preoperative, intraoperative, and postoperative variables were recorded using structured questionnaires and clinical documentation. Outcomes were evaluated over 6 months using a validated 5-point Likert scale, Oswestry Disability Index (ODI) components, and predefined FBSS criteria. Statistical analysis included chi-square testing, Anderson–Darling normality testing, independent t-tests, Levene’s test, correlation analysis, and multivariate logistic regression. Results: The incidence of FBSS in this cohort was 28.6%. Significant predictors included preoperative anxiety (p < 0.01), smoking status (p = 0.02), obesity (p = 0.03), severity of stenosis (p < 0.01), and surgery type, with open laminectomy demonstrating higher FBSS rates compared to minimally invasive surgery (p = 0.04). Logistic regression identified preoperative psychological distress (OR 2.74), high baseline pain levels (OR 1.89), and postoperative complications (OR 3.11) as independent predictors of FBSS. Conclusion: FBSS remains a multifactorial entity influenced by psychosocial, biomechanical, and procedural factors. The findings highlight the need for improved preoperative psychological screening, meticulous surgical planning, targeted lifestyle interventions, and structured postoperative rehabilitation strategies to reduce FBSS incidence.