Why Am I Still in Pain After Back Surgery? What Sioux Falls Patients Need to Know About FBSS
If you had back surgery expecting relief — and you're still hurting — I want you to know that what you're experiencing has a name, it's more common than you've probably been told, and it doesn't mean you're out of options.
Perhaps the pain never went away. Maybe it improved temporarily before returning. Or perhaps you're now experiencing new symptoms that didn't exist before surgery. Whatever the pattern, you are not imagining it and you are not alone.
I've been practicing chiropractic in Sioux Falls for nearly 50 years. A meaningful portion of the patients I see at Back Specialists have been through spinal surgery — sometimes more than once — and are still searching for lasting relief. Understanding why that happens is the first step toward finding a path forward.
What Is Failed Back Surgery Syndrome?
Failed Back Surgery Syndrome (FBSS) is defined by the International Association for the Study of Pain as "lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location."
In plain language: it is back pain that continues or develops after spinal surgery, in the same general area where you had the procedure.
The answer to whether the surgery failed is usually no. A back surgery can be technically successful, meaning the surgeon corrected the structural issue they were targeting, yet you may still have pain afterward. That distinction matters because it reframes what happened to you. Your surgeon may have done exactly what they set out to do. The problem is that surgery addresses one specific structural issue — and the spine, nerves, muscles, and joints are all interconnected in ways that a single procedure cannot fully account for.
According to research published by the American Society of Interventional Pain Physicians and other spine organizations, approximately 10 to 40 percent of spinal surgery patients may continue experiencing significant pain after surgery. For a procedure that carries real risk and significant recovery time, that is a sobering number — and one that most patients are not given clearly before they consent.
Why Does Back Pain Continue After Surgery?
Failed back surgery syndrome is a condition with a complex etiology and many factors that predispose patients towards chronic pain. There is rarely a single, clean explanation. The most common contributing factors are worth understanding in detail.
Scar Tissue Formation (Epidural Fibrosis)
One of the most common causes of FBSS is scar tissue formation around spinal nerves. After surgery, scar tissue naturally develops as part of the healing process. In most patients this causes no significant problems. But in some, excessive tissue can wrap around nerve roots and tether them to the bone. This scar tissue may adhere to nearby nerve roots and contribute to persistent pain during movement.
Symptoms of epidural fibrosis appear about 6 to 12 weeks after the procedure. If your pain seemed to improve initially and then returned or worsened around that timeframe, scar tissue is a likely contributor.
The Nerve Didn't Fully Recover
One of the most important and least-discussed realities of spinal surgery is that the nervous system is incredibly sensitive. If a nerve was squeezed for a long time before the surgery, it may have suffered internal damage. Removing the pressure is like removing a heavy weight from a crushed garden hose — sometimes the nerve does not fully recover even after pressure is relieved. This is one of the primary reasons why someone might still feel pain even if the MRI shows the blockage is gone.
This is particularly relevant for patients who waited a long time before having surgery. The longer a nerve is compressed, the more likely it is to have sustained damage that doesn't fully reverse once the structural problem is addressed.
Adjacent Segment Disease
The spine is dynamic. When a surgeon operates on one level, the mechanics of the entire back change. This shift in weight distribution is a major factor in why new pains can develop shortly after an operation.
When one segment of the spine is fused or altered, the segments immediately above and below it must compensate by absorbing additional stress. Over time, this can result in adjacent segment disease, in which a patient experiences pain and problems with a disc that is near the location of a previous surgery. The pain may feel new, may occur in a slightly different location than the original complaint, and may begin weeks, months, or even years after the procedure.
Incomplete Decompression or Wrong Surgical Level
There can be technical problems from decompression surgery such as a missed fragment of bone, incorrect level of surgery, trauma to the nerve root from splitting of the fibers, or inadequate decompression during the original surgery. These are not necessarily errors in the traditional sense — spinal anatomy is complex and highly individual — but they represent situations where the procedure did not fully address the source of the pain.
Sometimes back or leg pain is actually caused by problems with the hips or other structures, and a person may experience a worsening of the original condition after surgery. If the correct source of pain was not identified before the procedure, surgery on the wrong structure will not provide lasting relief regardless of how well the operation itself went.
Spinal Instability After Surgery
Back surgery often involves removing supporting structures such as a lamina, facet, or disc, which can weaken spinal structures. In some patients this creates instability at the surgical site — the surrounding vertebrae no longer have the same mechanical support they had before the procedure, which can lead to abnormal movement patterns, muscle guarding, and pain that persists long after the incision has healed.
Failed Spinal Fusion (Pseudoarthrosis)
When a spinal fusion does not successfully integrate — meaning the bone graft does not fully fuse the targeted vertebrae — the result is called pseudoarthrosis. The intended structural stability is never achieved, leaving the segment susceptible to continued motion and pain. Pseudoarthrosis is among the common pathologies found in failed back surgery syndrome patients.
Why More Surgery Is Usually Not the Answer
When you are in pain after back surgery, the natural instinct may be to go back to the surgeon and ask what can be done differently. In some specific situations — a clear structural problem that was missed, a hardware failure, an infection — additional surgery may be appropriate. But for most FBSS patients, some patients fail to improve even after the best surgical intervention. In spite of careful diagnosis and a successful operation, patients may continue to experience pain or limitations in performing daily activities.
Repeat surgeries carry compounding risk and progressively worse odds of success. Each procedure adds more scar tissue, more opportunity for nerve damage, and more disruption to the surrounding spinal structures. The research on repeat back surgery outcomes is consistent: the success rate drops significantly with each additional procedure.
Symptoms of failed back syndrome may appear immediately after surgery or develop after a few weeks, months, or years. Regardless of when they appear, pursuing more aggressive intervention before exhausting conservative options is rarely the right call. Most FBSS patients have not yet had a thorough trial of conservative care — and that is exactly where meaningful improvement is most likely to be found.
What Conservative Chiropractic Care Can Do for FBSS
Chiropractic care is one of the most well-supported conservative treatment options for patients dealing with post-surgical spinal pain. The key word is conservative — meaning non-invasive, drug-free, and carrying minimal additional risk to an already-compromised spine.
At Back Specialists, Dr. Bruce Jon Hagen treats FBSS patients exclusively with the Activator Method — a gentle, instrument-assisted chiropractic technique that delivers precise, low-force impulses to specific spinal joints without any twisting, cracking, or high-velocity manipulation.
This matters enormously for post-surgical patients for one specific reason: the Activator applies no torsional stress to the surrounding spinal structures. For a spine that has been surgically altered — with fused segments, hardware in place, or scar tissue present — the last thing you want is a high-velocity manual adjustment that places unpredictable mechanical stress on structures that are already compromised. The Activator's precision and low force make it the safest and most appropriate chiropractic approach available for this population.
What Chiropractic Care Can Address in FBSS Patients
For patients with Failed Back Surgery Syndrome, chiropractic care can:
Restore proper joint mechanics in spinal segments adjacent to the surgical site
Reduce nerve irritation and pressure caused by post-surgical misalignment
Decrease muscle tension and protective guarding around the surgical site
Improve range of motion and functional mobility
Address compensatory pain patterns in the hips, pelvis, and thoracic spine that develop after lumbar surgery
Support the body's natural healing process without adding new risks or interventions
Chiropractic care is not a reversal of surgery. It cannot remove scar tissue or undo structural changes. What it can do is optimize the function of the spinal segments that remain, reduce the neurological irritation that drives much of the pain, and help the body move more efficiently within the constraints of its post-surgical anatomy.
Why Dr. Hagen Is Specifically Qualified to Treat FBSS
Not every chiropractor is equipped to evaluate and treat a post-surgical spine. It requires a thorough understanding of spinal anatomy, familiarity with the most common surgical procedures and their structural consequences, and the clinical judgment to adapt treatment to a spine that has been permanently altered.
Dr. Bruce Jon Hagen brings qualifications to this work that are genuinely rare in the Sioux Falls chiropractic market:
Nearly 50 years of clinical experience including extensive work with complex post-surgical cases
Advanced Proficiency Rated status in the Activator Method — the highest credential available and one of only 5 in the Sioux Empire
Over 1,700 hours of post-graduate X-ray interpretation and spinal diagnosis
Graduate of the Whiplash Masters' Program — Spine Research Institute of San Diego
AMA Impairment Rating certification in the 4th, 5th, and 6th Editions
Advanced post-graduate training in personal injury, cervical trauma, and acute patient management
Named South Dakota Chiropractor of the Year by his peers in 2009
Dr. Hagen has a particular clinical interest in the complex cases that other providers find difficult — and FBSS is exactly the kind of case where that depth of experience and training makes a meaningful difference in outcomes.
What to Expect at Your First Visit
FBSS patients often arrive at Back Specialists after months or years of trying other things. We take that history seriously and approach every post-surgical patient with the thoroughness their situation requires.
At your first appointment, Dr. Hagen will:
Review your complete surgical history, including all procedures, hardware placed, and any imaging you have from before and after surgery
Discuss your current symptoms in detail — where the pain is, what makes it better or worse, how it has changed since the operation
Perform a thorough orthopedic and neurological examination to assess your current spinal function, nerve involvement, and range of motion
Review your existing imaging or take new X-rays if clinically indicated
Develop a personalized, conservative treatment plan tailored specifically to your post-surgical spine — not a generic back pain protocol
There is no single protocol for FBSS. Every patient's surgical history, anatomy, and current presentation is different. Your care plan will reflect that.
You Don't Have to Accept Chronic Pain as Your New Normal
Still in pain after spine surgery? You do not have to accept chronic pain as your new normal. A surgical history does not close the door on meaningful improvement. It just means the path forward requires a provider who understands what surgery does and doesn't change — and who has the clinical tools to work safely and effectively within those constraints.
At Back Specialists in Sioux Falls, Dr. Hagen has helped patients with some of the most complex post-surgical spinal histories in the region find meaningful, lasting relief. If you've been told there's nothing more that can be done, we'd like to offer a second opinion.
Call or text 605-361-1700. Same-week appointments are available.
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