Back surgery is often the last resort when other methods of pain control have failed. Unfortunately, back surgery itself can fail to relieve pain, even worsening existing pain or creating new pain in some cases. This occurrence is often referred to as failed back surgery syndrome.
People may undergo back surgery for a variety of reasons.
When people have back surgery to try to control pain, it’s usually to correct nerve compression. Nerve compression can occur as a result of bulging or herniated discs. An overgrowth of bone that narrows the spinal canal can also compress the nerves; this condition is called spinal stenosis.
Many different types of back surgery can be attempted to correct the issues. Spinal fusion, which involves joining two or more bones together, is one of the most common types of back surgery for pain. Foraminotomy or laminectomy surgeries are both performed to remove parts of the bones in the spine. A discectomy is the removal of a bulging disc, while a disc replacement involves the removal of a damaged disc followed by the installation of an artificial disc. An interlaminar implant is the insertion of a U-shaped implant between the bones of the back to maintain the space between the bones.
It’s also possible for multiple surgical techniques to be utilized during the same surgery. For instance, a discectomy might be performed at the same time as a spinal fusion.
The main symptom of failed back surgery is pain.
Initially, people who have undergone back surgery may experience lessened pain at first. In those whose back surgery fails, the pain will begin to increase after three to six months. A dull ache in the back and legs is common of people with failed back surgery syndrome. Midwest Orthopaedics at RUSH describes the pain that can occur after failed back surgery, stating:
“Patients with failed spinal surgery have either a new or persistent pain in the back or legs following spine surgery. The pain may be similar to the pain experienced before surgery, or it could be a new pain of a different degree or in a different spot.”
Pain may not be the only symptom, though. There may also be sensations of pricking or stabbing in the extremities. All of this can cause significant difficulty in carrying out day-to-day activities.
Researchers have identified quite a few risk factors that increase the likelihood that back surgery will fail or cause pain.
Medications taken prior to back surgery can have a big impact. One study has found that taking opioids prior to back surgery increases the likelihood of failed back surgery. This might be partly because opioid use is associated with depression and other psychiatric problems, which can also significantly impact surgical outcome. The higher the dose of opioid medications an individual takes prior to back surgery, the higher his or her risk is for surgical failure.
Additionally, low levels of vitamin D can increase the risk of a poor surgical outcome. This may potentially be because vitamin D aids in calcium absorption, which plays a part in new bone formation, so a vitamin D deficiency might negatively impact the body’s ability to form new bone after surgery. Unfortunately, it’s been found that many spinal surgery patients have lowered vitamin D levels. However, a blood test is all that’s required to identify lowered vitamin D levels, and a doctor-recommended regimen of supplements can easily get vitamin D levels back to normal.
Overall, the best way to ensure a good back surgery outcome is to be in the best possible physical and mental health. Exercise, even a few minutes of daily walking, can make a difference. Eating healthier can also help, as can quitting tobacco use. Before undergoing back surgery, speak to a physician or the surgeon who will be performing the procedure, and ask which (if any) medications to stop. Also consider asking for a specialized routine of stretches or exercises, or for a reference to a physical therapist.
Several causes of failed back surgery syndrome have been identified, but new research is looking for ways to lower the risks.
Some people experience failed back surgery because the surgery was performed incorrectly. Other times, the underlying issue might have been incorrectly diagnosed or an inappropriate surgical procedure might have been performed. Unfortunately, one of the potential problems with spinal surgery is incorrect location of the procedure.
The bones of the spine all look similar, so surgeons sometimes perform a procedure on the incorrect segment of the spine. Researchers are developing ways to avoid this problem. One way this might be avoided in the future is the use of a computer program that lines up patient X-rays and magnetic resonance imaging (MRI) tests and overlays landmarks onto the X-ray for the surgeon. This way, the surgeon is able to better visualize where to perform the surgery, instead of having to count vertebrae during surgery to find the correct location.
Incorrect patient selection can also cause issues. Complications during or immediately after back surgery can increase the risk of back surgery failure, too. Scar tissue might form as a result of surgery or injury, which can compress nerves and cause pain. A failure to carry out pre- and post-operative physical therapy can increase the risk of failed back surgery as well.
However, one group of researchers has found that phone counseling both before and after the surgery can help with this. Phone counselors discuss the importance of pre- and post-operative exercise and physical therapy with patients, which results in less pain and disability after surgery.
Even if the surgery goes as well as possible, the recurrence of pain can occur due to ongoing degeneration of the spinal discs or recurrent disc herniation. Additionally, some surgeries, such as those that alter the spine’s biomechanics like spinal fusion, can result in a load increase on adjacent spinal segments. This can accelerate disc degeneration and cause pain and instability. Researchers are currently utilizing complex computer models to better understand the mechanics of the spine, which will help them understand how to avoid load transference after spinal fusion surgery.
Another group of researchers are attempting to identify molecular changes that occur during the onset of acute pain after back surgery. This acute pain can cause molecular changes that may cause permanent damage to neurons, increasing the risk of chronic back pain after surgery. If these molecular changes can be identified and studied, it may be possible to prevent or reverse them.
Treating failed back surgery syndrome can be difficult, but there are many different options to try.
The first step in treating failed back surgery syndrome is a thorough examination to identify specific symptoms and etiology, as well as rule out potential causes of pain outside the spine. Medications might be utilized to help control pain. For instance, non-steroidal anti-inflammatory drugs (NSAIDs) and certain antidepressants can help control pain from failed back surgery syndrome. Additionally, opioids can be beneficial, if used as prescribed under direction of a physician.
Chiropractic adjustments might also provide some relief from pain. Methods of pain control that interrupt pain signals along the nerves may prove effective, as well. Transcutaneous electrical nerve stimulation (TENS), nerve block injections, or trigger point injections all block nerve signals. Epidural steroid injections also sometimes do this, in addition to providing the anti-inflammatory properties of injected steroids.
If other methods of pain control don’t control discomfort well enough, spinal cord stimulation (SCS) might be attempted. Like other methods of pain control, SCS blocks pain signals along the nerves. However, SCS, which involves the installation of electrodes along the spine, allows the individual to use a remote to activate it when needed.
Have you experienced pain from failed back surgery?
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