Failed back surgery syndrome (FBSS) is a term describing persistent or recurring low back pain and/or leg pain following spinal surgery that was intended to relieve it. FBSS is not a failure of surgery technique per se -- it is the continued presence of pain after anatomically successful surgery, reflecting the complex pain mechanisms involved in chronic spinal conditions. Common causes include: epidural fibrosis (scar tissue around nerve roots), arachnoiditis, adjacent level disease, recurrent disc herniation, instability, and central sensitisation. FBSS affects 10-40% of spinal surgery patients and is a major source of chronic disability.
FBSS Features Affecting Walking
| FBSS Mechanism | Walking Impact | Cane Role |
|---|---|---|
| Epidural fibrosis with nerve root tethering | Radicular leg pain with walking; neurogenic claudication; weakness | Cane reduces nerve root tension per step; extends walking distance before pain forces stop |
| Arachnoiditis | Severe burning leg pain; neurological deficits; highly variable | Cane as needed depending on residual motor and sensory deficits |
| Adjacent segment disease | New disc herniation or stenosis above/below fusion level; radiculopathy | Cane for radicular leg weakness or neurogenic claudication |
| Post-fusion instability or hardware failure | Mechanical back pain with walking; potential nerve root involvement | Cane reduces spinal loading per step; may reduce axial pain with walking |
| Central sensitisation | Allodynia; widespread pain; pain disproportionate to pathology | Cane for safety and confidence; energy conservation; psychological support |
FBSS and Spinal Cord Stimulation
Spinal cord stimulation (SCS) is the most evidence-based treatment for FBSS with dominant leg pain. SCS reduces pain and improves walking distance in FBSS patients who have failed conservative management. In the PROCESS trial and other RCTs, SCS patients showed significantly better pain reduction and quality of life than those managed with conventional medical management alone. A cane that is needed before SCS may no longer be needed if SCS provides adequate pain relief.
The Cane as a Pacing Tool in FBSS
Many FBSS patients have variable pain -- worse in the morning, better after activity, then worsening with fatigue. Pacing (managing activity to stay within pain tolerance) is a core chronic pain management strategy. A cane assists pacing by reducing the per-step pain provocation, allowing the patient to engage in more walking at a tolerable level before reaching their pain threshold.
Explore DaiWalk walking canes. Related: Walking Cane for Spinal Cord Stimulation | Walking Cane for Lumbar Stenosis.
