The cost-effectiveness of revision surgery for failed back surgery syndrome (FBSS) remains unclear.

     We set out to assess cost-effectiveness of revision surgery for adjacent segment disease (ASD), pseudoarthrosis, and same-level recurrent stenosis over a two-year follow-up period.

     150 patients undergoing revision neural decompression and instrumented fusion for adjacent segment disease(ASD, n=50), pseudoarthrosis(n=47), or same-level recurrent stenosis(n=53) were included.

     Two-year patient-reported outcomes (PRO), back-related medical resource utilization, and work-day losses were prospectively assessed via phone interview and used to calculate Medicare fee-based direct cost and indirect costs from occupation loss. Mean total two-year cost per QALY gained after revision surgery was assessed.

     Pre-operative EQ-5D for patients with ASD, pseudoarthrosis, and same-level recurrent stenosis was 0.30±0.28, 0.37±0.17, and 0.18±0.22, respectively. Mean cumulative two-year health-state gain for these 3 cohorts following surgery was 0.76 QALYs, 0.35 QALYs, and 0.84 QALYs, respectively. Mean±SD total two-year cost of surgery following ASD, pseudoarthrosis, and same-level stenosis was $47,846±32,712, $41,631±$9,691, and $49,431±7,583, respectively. Revision surgery for ASD, pseudoarthrosis, and same-level stenosis was associated with mean two-year cost per QALY gained of $62,955, $118,945, and $58,846, respectively.

     This is a retrospective study.

     Revision fusion for FBSS was associated with significant improvement in quality of life at two years. Surgical management of adjacent segment disease and same-level recurrent stenosis were shown to be cost-effective at $62,955 and $58,846 per QALY gained, respectively.

     Surgery for pseudoarthrosis was shown to be poorly cost-effective at $118,945 per QALY gained. Our results suggest that revision neural decompression and fusion for FBSS is a valuable treatment option.