Most patients with failed spine surgery have a "peripheral" mechanical structural lesion as a source of nociception. Because of the iatrogenic changes associated with surgical intervention, identifying the source of symptoms is difficult. Occult lesions are expected to be more frequent in these patients than in those not previously operated on, and may explain the failure of surgery. A systematic approach is necessary to evaluate the various factors in both central and peripheral nervous systems that contribute to the patient's experience of pain. The spinal lesions most often associated with failed surgery are discussed below.

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