Failed back surgery syndrome and heart health: What spine surgeons need to know?

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Created On: 30/05/2026

Failed back surgery syndrome (FBSS), also known as postlaminectomy syndrome (PLS), is a chronic pain condition characterized by persistent or recurring symptoms after lumbar spine surgery.

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Key take away

Failed back surgery syndrome may signal broader systemic inflammation and increased cardiovascular disease risk.

Background

Failed back surgery syndrome (FBSS), also known as postlaminectomy syndrome (PLS), is a chronic pain condition characterized by persistent or recurring symptoms after lumbar spine surgery. Chronic pain disorders have been increasingly linked to systemic inflammation, autonomic nervous system dysfunction, and elevated cardiovascular (CV) risk.

Method

Investigators executed a study via the TriNetX Global Collaborative Network database. Adults aged 18 years and older who underwent PLF were identified through current procedural terminology coding data. The study cohort included patients diagnosed with PLS at least 6 months after surgery, while matched controls were allocated a comparable postoperative index date. Researchers evaluated the 5-year rates of:

Major cardiac events (MCE)
Stroke
Major adverse cardiovascular events (MACE), defined as MCE plus stroke

Propensity score matching accounted for demographics, comorbidities, and medication use. Odds ratios (ORs) with 95% confidence intervals (CIs) were checked.

Result

Following matching, 6,384 patients were included in each group. In this large retrospective cohort study, patients with FBSS/PLS showed greater long-term CV risk compared with controls (Table 1):

Stroke risk was not significantly elevated (OR 1.11, 95% CI 0.92-1.34).

Conclusion

PLS after PLF was associated with a higher long-term risk of major cardiac complications. The findings suggest that failed back surgery syndrome may act as a marker of systemic inflammatory burden and CV vulnerability, underscoring the importance of long-term cardiac monitoring, multidisciplinary postoperative management, and risk-reduction strategies in patients with chronic pain after spine surgery.