The Roles of the Hip, Spine, Sacroiliac Joint, and Other Structures in Patients with Persistent Pain after Back Surgery

Failed back surgery implies that the outcome of spine surgery did not meet the expectations of the patient and surgeon. The structural cause of failed back surgery syndrome can be identified in 90% of patients. The outcome of treatment is best when treatment is specific for the cause of pain. The most common spinal causes include pain from a disc at the index or adjacent level, pain from a facet or sacroiliac joint, and neuropathic pain. Common extraspinal causes include primary hip disorders and greater trochanteric bursitis. Treatment options include rehabilitation, spinal injections and interventions, medications, and salvage surgery and should be based on the medical evidence and the cause of pain.