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

Why This Matters

Failed Back Surgery Syndrome (FBSS) represents a challenging clinical population—patients with persistent pain following spinal surgery and often limited treatment options. These patients frequently cycle through medications, injections, and additional procedures with variable success. Identifying effective non-surgical options for this group is clinically important.

What the Research Found

This case series evaluated outcomes in 61 patients with cervical and lumbar FBSS treated using Cox flexion-distraction spinal manipulation by 21 certified providers across multiple clinics.

Patients underwent an average of 12.9 treatments over approximately 8 weeks, with outcomes measured using pain scales and validated functional questionnaires.

Key Findings:

    • Patient-reported pain improvement averaged 65.9%, closely matching provider-reported improvement (67.2%)
    • Significant reductions in neck disability scores at both 3 and 12 months
    • Pain scores (NPRS) improved for both cervical and lumbar patients at 3 and 12 months
    • Broader improvements noted across:
      • Physical function
      • Pain interference
      • Anxiety and depression
      • Sleep and social function

Benefits were sustained up to 12 months

Clinical Takeaways

    • Recognize that patients with FBSS may still respond to targeted conservative care despite prior surgical intervention
    • Be aware that meaningful improvements were observed across pain, function, and psychosocial domains
    • Consider that outcomes were achieved with a relatively short treatment course (~13 visits over ~2 months)
    • Understand that sustained improvements at 12 months suggest potential longer-term benefit
    • Interpret results cautiously given case series design and lack of control group

Where Collaborative Spine Care May Support This

Chiropractors trained in Cox flexion-distraction may offer a non-surgical treatment option for patients with persistent post-surgical spine pain. This technique utilizes controlled, segment-specific spinal distraction and has established protocols for managing complex spine conditions, which may be particularly relevant in patients with altered spinal biomechanics following surgery.

Reference

Kruse RA Jr., White BA, Rogers CJ, Klamson J, Gudavalli MR. Failed Back Surgery Syndrome Patients Undergoing Flexion Distraction Chiropractic Treatment: A Case Series. J Chiropr Med. 2025.