Improper preoperative patient selection before back surgery is the most common cause of failed back surgery syndrome. Surgeons look for an anatomic lesion in the spine that they can correlate with a patient’s pain pattern. Some lesions are more reliable than others. For example, degenerative disc disease is less commonly correlated with patients back pain than leg pain from a disc herniation pinching a nerve root. There are other sources of pain that can mimic back pathology such as piriformis syndrome, sacroiliac joint dysfunction and hip pathology (such as hip osteoarthritis). Your neurosurgeon can help determine why your issues still persist. Often a new diagnosis is made that may be different than the original one. Treatments can be very successful and can include directing them toward another cause or providing more global pain coverage with the latest technologies.