Background: We aimed to investigate the incidence and risk factors for failed back surgery syndrome (FBSS) following open posterior lumbar surgery for degenerative lumbar disease (DLD).Method: A multivariate regression analysis was performed for 333 consecutive patients to identify potential risk factors for FBSS. Clinical outcomes were evaluated by the validated North American Spine Society (NASS) Questionnaire and numerical rating scale (NRS) for pain. Demographics, diagnostic characteristics, surgical data, radiographic parameters for each patient were analyzed. Result: 16.8％ of the included patients were classified as FBSS. Univariate analysis showed that age, hypertension, symptom location, intermittent claudication, preoperative pain NRS-leg, HIZ, Modic changes (MCs), surgical strategy and postoperative rehabilitation were related to FBSS. Multivariate logistic regression analysis demonstrated that preoperative NRS-leg (OR:0.80, 95%CI:0.71-0.91, P=0.001), hypertension (OR: 2.22, 95%CI: 1.10-4.51, P=0.027), intermittent claudication with waking distance > 100m (OR: 4.07, 95%CI: 1.75-9.47, P=0.001) and waking distance ≤ 100m (OR: 12.43, 95%CI: 5.54-27.92, P＜0.001), HIZ (OR: 8.26, 95%CI: 4.00-17.04, P＜0.001), MCs (OR: 3.41, 95%CI: 1.73-6.71, P＜0.001), postoperative rehabilitation (OR: 2.63, 95%CI: 1.13-6.12 , P=0.024) were risk factors for FBSS.Conclusion: Open posterior lumbar surgery is an effective treatment for DLD which provide pain reduction and lumbar curve improvement with a considerable satisfaction rate. Lower preoperative NRS-leg, hypertension, intermittent claudication, HIZ, MCs and postoperative rehabilitation are risk factors for FBSS, who can serve as a tool for clinicians to identify at-risk population and provide more effective management to mitigate the doctor-patient contradicts and further occupation of medical resources.