Failed back surgery syndrome — the clinical term for persistent or recurring pain after spinal surgery — affects an estimated 10-40% of patients who undergo lumbar procedures. It’s one of the most frustrating situations in all of spine care: a patient goes through surgery hoping for relief, and ends up in equal or worse pain on the other side.
The question I get from these patients: Is there anything that can actually help now?
Sometimes VAX-D is part of the answer. Sometimes it isn’t. Here’s the honest clinical picture.
What “Failed Back Surgery Syndrome” Actually Includes
FBSS isn’t a single condition — it’s a category that includes several different clinical realities:
Adjacent segment disease: After a spinal fusion, the segments above and below the fusion bear increased load because the fused segment no longer moves. Over time — sometimes years, sometimes decades — those adjacent segments develop accelerated degeneration, disc herniation, or stenosis. This is one of the most common causes of new or recurring symptoms after fusion.
Residual nerve damage: If a nerve root was significantly compressed for a long period before surgery, the nerve itself may have sustained damage that surgery cannot fully reverse. Post-surgical pain can reflect nerve injury rather than ongoing compression — decompression can’t fix nerve damage that’s already occurred.
Scar tissue (epidural fibrosis): Surgery creates scar tissue in the epidural space. This scar tissue can adhere to nerve roots and create chronic irritation that mimics the original radiculopathy. Epidural fibrosis is frustratingly resistant to most treatments.
Incorrect diagnosis pre-surgery: Sometimes the surgery addressed a structural finding that wasn’t actually the pain generator. The imaging looked like the problem, but the actual source of pain was something else — facet joint, sacroiliac joint, or central sensitization — that the surgery didn’t address.
Hardware complications: Instrumentation issues, adjacent segment failure at the fusion site, or pseudarthrosis (failed fusion) can produce persistent pain.
New disc herniation at an unfused level: A patient with a prior fusion at L4-L5 who develops a new herniation at L5-S1 has a different problem than their original surgery addressed — and this new herniation may be very treatable.
Where VAX-D Can Help After Surgery
The key principle: VAX-D can help when there is a disc-mediated mechanical problem that is separate from or adjacent to the surgical site, and when the hardware doesn’t contraindicate traction forces.
Adjacent segment disease with disc involvement: This is the clearest indication for VAX-D in post-surgical patients. If a patient with a prior L4-L5 fusion develops a new herniation at L3-L4 or L5-S1, that adjacent level has disc pathology identical to what the original surgery addressed — and it can respond to decompression just as a non-surgical disc herniation would. The fusion doesn’t prevent treatment at adjacent levels.
Non-fused levels with residual disc pathology: Some surgeries (discectomy, laminectomy) don’t fuse anything — they remove disc material or bone without hardware. If the original problem recurs, or if a different level develops herniation, decompression is often appropriate.
Chronic discogenic pain at unfused levels: Patients with multi-level degenerative disc disease who had a single-level fusion may continue to have pain from unfused levels. Those levels can be addressed with decompression.
Where VAX-D Cannot Help
This is equally important:
Hardware contraindications: Certain types of spinal instrumentation contraindicate traction forces. Pedicle screw systems, in particular, require careful evaluation. The type of hardware, its condition, and the integrity of the fusion all affect whether distraction forces are safe. This requires imaging review — not a general rule.
Epidural fibrosis: If the source of persistent pain is scar tissue adhering to nerve roots, VAX-D cannot address that mechanism. The scar tissue doesn’t retract under negative pressure the way disc material does.
Nerve injury pain: If a nerve root was permanently damaged before or during surgery, decompression cannot repair that nerve. Neuropathic pain from nerve injury requires a different treatment approach entirely — neuromodulation, medication management, or pain psychology.
Pseudarthrosis or hardware failure: Unstable spinal segments — including failed fusions — are contraindications to decompression traction.
The Evaluation Process for Post-Surgical Patients
Evaluating a post-surgical patient for decompression requires more thoroughness than a standard new disc patient. We need:
- All imaging — pre-surgical MRI, post-surgical imaging, and the most recent MRI. We’re mapping what was done, what changed structurally, and what the current anatomical picture looks like.
- Operative report if available — knowing exactly what levels were addressed, what was removed, and what hardware was placed is essential for safety evaluation.
- Complete symptom history — specifically, how symptoms changed post-surgery, whether there was a pain-free interval, and how symptoms now compare to the pre-surgical presentation.
- Medication and injection history — particularly any post-surgical interventions and their effect.
This is a more complex picture than a first-time disc patient, and we treat it accordingly. We’re not going to put a post-surgical patient on the table without a complete understanding of what was done and what we’re working with now.
A Word About Expectations
Post-surgical patients often have more complex pain pictures — a mix of mechanical, inflammatory, and neuropathic components that developed over years of treatment. The response to decompression is correspondingly less predictable. Some patients with adjacent segment disease respond beautifully. Others with primarily neuropathic pain or significant scar tissue respond poorly.
What I can offer is an honest evaluation that distinguishes the treatable components from the ones that require a different approach. Sometimes the answer is “yes, the adjacent level herniation is exactly what VAX-D is designed for.” Sometimes it’s “what you’re describing sounds more like central sensitization, and what you need is a pain management specialist.” We’d rather give you the right answer than the one that gets you to schedule a package of sessions.
Get an Evaluation Before Scheduling More Surgery
If you’ve had spinal surgery and are still in pain — or the pain has returned — it’s worth an evaluation to understand whether there’s a non-surgical component that can be addressed before considering revision surgery. Revision spinal surgeries have higher complication rates and lower success rates than primary surgeries. If there’s a meaningful chance that non-surgical treatment can help, that conversation is worth having first.
Call 631-659-2980 or schedule your evaluation online. West Hills Chiropractic Pain Center, 400 W Jericho Turnpike, Huntington, NY 11743.
— Dr. Tom Oddo, DC CSCS CEAS, West Hills Chiropractic Pain Center