Why Does My Back Still Hurt After Surgery?
Failed back surgery syndrome means pain that continues, or comes back, after spine surgery. It does not mean the operation was done badly. Often, the first scan missed an alignment or compensation problem. Such a problem only shows when you are standing and carrying your body weight. A full standing assessment can show what a lying-down scan could not.
Key Points
- Up to 40% of people who have spine surgery still have significant pain afterwards.
- The cause is not always where the operation was done. Your body may be compensating somewhere else.
- Standard lying-down scans can miss alignment problems that appear only when standing.
- An EOS standing scan captures your whole spine, pelvis and legs in one weight-bearing image.
- Understanding the alignment of your whole body can help guide the right next step. That may be further treatment, rehabilitation or a second opinion.
What is failed back surgery syndrome?
Failed back surgery syndrome is also called post laminectomy syndrome or persistent spinal pain syndrome. It is a broad term for ongoing back or leg pain after one or more spine operations. The name is misleading. It does not necessarily mean the surgeon made a mistake. In many cases, the surgery fixed the problem it was meant to fix. The pain continues because another factor was not found before the operation.
That factor is often alignment. Your spine does not work on its own. It connects to your pelvis, hips and legs. If the overall balance between these parts is not considered, surgery on one segment can leave the bigger picture unchanged. It can even create new stresses elsewhere.
What does back pain after surgery feel like?
Pain after spinal fusion or decompression can take many forms. Some people notice the same pain they had before. Others develop new symptoms in a different area. Common patterns are listed below.
The original ache comes back weeks or months after surgery, sometimes slowly.
Discomfort moves to the hip, buttock, thigh, or the segment above or below the operated area.
Difficulty bending, walking or standing for long periods, especially after a fusion.
Shooting pain, tingling or heaviness in one or both legs that may get worse when upright.
Important. If you develop sudden weakness in your legs, loss of bladder or bowel control, or numbness in the area around your groin or back passage, get urgent medical help. Contact your doctor or go to the nearest emergency department straight away. These symptoms need immediate assessment.
Why does pain continue after spine surgery?
There is rarely one single reason. Pain after spine surgery usually involves a mix of factors. Several may be present at the same time.
After a fusion, the levels above or below work harder. This can speed up wear at those segments.
If your spine's front-to-back curve is not properly restored, your body leans forward. Your muscles then strain to keep you upright.
Scarring around the nerves after surgery (epidural fibrosis) can cause nerve irritation or tethering.
Long-term pain can change how your nervous system processes signals. This can keep pain active even after the original problem has been addressed.
Your pelvis may tilt, your knees may bend slightly, or your hips may shift. These compensations create new sources of strain that lying-down scans cannot detect.
Many of these problems involve facet joint arthropathy or spinal stenosis at levels that were not part of the first operation. You can read more on our back pain clinic page.
How does a standing scan show what lying-down scans miss?
Standard scans after an operation, including X-ray, CT and MRI, are usually done while you lie down. When you lie flat, gravity is removed. Your muscles relax. Your spine settles into a position it would never hold in daily life. So alignment problems, pelvic tilts and compensation patterns can disappear from the image completely.
An EOS scan is different. You stand naturally in the scanner, carrying your body weight, just as you do in daily life. The system captures your whole skeleton from head to feet in a single image using about 90% less radiation than a standard X-ray, around ten times less. This means your consultant can see whether your spine, pelvis and legs are working together, or whether one area is compensating for another.
This is especially useful for someone with pain after spinal fusion. A standing image can show pelvic retroversion (where your pelvis tilts backward to counterbalance a stiff spine), knee flexion (where you unconsciously bend your knees to stay upright), or sagittal imbalance where your head drifts forward of your pelvis. None of these show up reliably when you are lying flat.
At ScanAlign, standing EOS imaging in London, we produce a detailed alignment report. Your surgeon, physiotherapist or pain specialist can use it to plan your next steps. Learn more about when doctors recommend an EOS scan.
When MRI is the better tool. EOS shows bones, joints and alignment. If your medical team needs to check soft tissue, disc problems, nerve compression or scar tissue around the spinal cord, MRI is usually the right choice. Many people benefit from both, because each answers a different question.
What should you do if your back still hurts after surgery?
Start by understanding the full picture. If your scans after the operation were done lying down, there may be alignment information that has never been captured. A standing assessment does not replace the opinion of your surgical team. But it can add a piece of the puzzle they have not yet seen.
If you are thinking about a second opinion on your back surgery, a standing alignment scan gives your new consultant objective, weight-bearing data to work with.
Book a free video consultationYou do not need a referral from your doctor to book an independent standing assessment. Many people come to us after surgery, either on a consultant's advice or on their own. We send the full report directly to whoever is managing your care.
Before you start a new treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
Frequently asked questions
It is a term for ongoing or new pain after spine surgery. It does not mean the operation was done incorrectly. Often it means the original cause of pain was not fully found, or a new source of strain has developed.
Studies suggest that a significant share of people, sometimes estimated at up to 40%, still have meaningful pain after spine surgery. The figure varies with the type of surgery and the condition being treated.
Yes. When you lie flat, gravity is removed and your muscles relax. Alignment problems such as pelvic tilt, sagittal imbalance and compensation patterns can be invisible. A standing EOS scan captures your skeleton while it carries your real body weight.
Yes. EOS uses low-dose X-ray technology, not magnets, so metal implants are not a concern. The scan uses about 90% less radiation than a standard X-ray, around ten times less.
No. You can refer yourself. Many people come to us on their own after surgery. We send the report to whichever clinician is managing your care.
It produces a full-length image of your skeleton from head to feet while you stand. This shows the alignment of your spine, pelvis, hips, knees and ankles. It also shows how each area relates to the others under gravity.
The scan itself does not make treatment recommendations. It provides detailed alignment data. Your surgeon or specialist can use it to decide whether revision surgery, rehabilitation or another approach is most suitable.
We are a private, self-pay clinic. The price for patients travelling from abroad is confirmed during the free video consultation.
They describe the same situation. Post laminectomy syndrome is an older medical term. Failed back surgery syndrome and persistent spinal pain syndrome are the names more commonly used today. All of them refer to ongoing pain after spine surgery.
Start with a free video consultation. We will discuss your history, explain what the scan involves and confirm it is the right step for you. There is no obligation to go ahead.
Still in pain after back surgery?
A standing alignment scan can show what lying-down scans may have missed. Start with a free video consultation, with no obligation.
Book a free video consultationSources
- Daniell JR, Osti OL. Failed Back Surgery Syndrome: A Review Article. Asian Spine Journal. 2018;12(2):372-379.
- Glassman SD, et al. The impact of positive sagittal balance in adult spinal deformity. Spine. 2005;30(18):2024-2029.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NG59. 2016 (updated 2020).
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.