Failed Back Surgery Syndrome Patients Undergoing Flexion Distraction Chiropractic Treatment: A Case Series

Why This Matters

Patients with FBSS (persistent or recurrent pain after spinal surgery) are often difficult to manage. Surgical options may have been exhausted, medications can carry risks (especially long‑term opioids), and conservative therapies show variable success. Understanding non‑surgical interventions that can meaningfully reduce pain, improve function, improve quality of life, and possibly reduce reliance on medications is highly relevant for day‑to‑day clinical care.

What the Research Found

  • Study Design & Population: A case series of 61 patients with cervical or lumbar FBSS (pain in or near the region of previous surgery), treated by 21 chiropractors certified in Cox Technic flexion‑distraction spinal manipulation. ScienceDirect
  • Treatment Course: On average ~12.9 treatments over ~56.3 days. ScienceDirect
  • Outcomes:
    • Patients and treating doctors reported mean pain relief of ~66‑67% (SD ~28‑29%). ScienceDirect
    • Function and disability (e.g. Neck Disability Index) improved: NDI decreased by ~6.4 points at 3 months, ~2.7 points at 12 months. ScienceDirect
    • Pain (measured by Numerical Pain Rating Scales, NPRS) for both neck and lumbar problems dropped significantly at 3 and 12 months. ScienceDirect
    • Broader patient‑reported outcomes (PROMIS‑29), including physical function, pain interference, sleep disturbance, fatigue, depression/anxiety, spine/leg/arm pain, social roles, etc., also improved. ScienceDirect

Clinical Takeaways

    • FBSS patients may derive substantial pain relief (~65‑70%) from repeated treatments using Cox flexion‑distraction spinal manipulation, even when prior surgery failed to resolve symptoms.
    • Improvements are not only in pain, but in function and quality of life (sleep, mental health, social roles).
    • The benefits appear durable at least out to 12 months for many outcome measures.
    • While the mean number of treatments is moderate (~13 over 2‑3 months), the treatment duration and frequency may need to be individualized.
    • Because FBSS often includes structural and non‑structural contributors (scar tissue, altered biomechanics, possibly persistent disc issues or stenosis), the gentle, decompressive nature of flexion‑distraction may help with symptoms without the risks of more aggressive thrust or surgical revision.
    • Use of patient‑reported outcome measures (pain scales, disability indices, PROMIS) is helpful to document progress over time.

Where Collaborative Spine Care May Support This

In a multidisciplinary approach, chiropractic/manual therapy such as Cox flexion‑distraction may serve as a non‑invasive option to reduce pain and improve function, potentially reducing the need for escalation (e.g. stronger medications or additional surgeries). Collaboration with surgical, pain medicine, physical therapy, and behavioral health colleagues can help in identifying which patients are most likely to benefit, monitoring outcomes (including opioid use), and providing adjunctive therapies (rehab, psychosocial support, etc.).

Reference

Kruse RA Jr., White BA, Rogers CJ, Klamson J, Gudavalli MG. Failed Back Surgery Syndrome Patients Undergoing Flexion Distraction Chiropractic Treatment: A Case Series. Journal of Chiropractic Medicine. 2025. DOI: 10.1016/j.jcm.2025.08.004. Full article available via [ScienceDirect] PubMed link likely via DOI. ScienceDirect