Failed Back Surgery Syndrome: A Comprehensive Review of Medical Management, Therapeutic Strategies, and Outcome Optimization

Failed Back Surgery Syndrome (FBSS) represents a persistent clinical and public health challenge, characterized by chronic pain and functional impairment following spinal surgery. This review integrates current scientific evidence with expert insights from Mexico, Colombia, and Ecuador to examine the multidimensional nature of FBSS and its implications for diagnosis and management. Four analytic domains were explored: etiological factors, therapeutic utilization patterns, perceived treatment effectiveness, and patient progression through a multimodal management pathway. Findings reveal a significant mismatch between commonly used therapies and those perceived as most effective, with pharmacologic management dominating early care despite its limited long-term benefit. Rehabilitation, psychological interventions, and spinal cord stimulation demonstrate substantially higher effectiveness but remain underutilized due to systemic, logistical, and educational barriers. The progressive attrition observed along the care pathway highlights critical gaps in multidisciplinary integration, timely referral, and access to advanced neuromodulation. Collectively, the results support a shift toward a comprehensive biopsychosocial framework for FBSS, emphasizing early multidimensional evaluation, expanded access to evidence-based therapies, and alignment of clinical decision-making with proven long-term outcomes. This approach is particularly relevant for improving patient care within diverse healthcare systems across Latin America.