Most of the time spine surgery achieves its goal, with pain relief being among the top benefits for beleaguered back or neck pain sufferers. But occasionally, a patient’s pain and other symptoms return – a situation known as failed back surgery syndrome – which isn’t necessarily as doom-and-gloom as it sounds, according to Praveen Kadimcherla, MD, an orthopedic spine surgeon at Atlantic Spine Center.
The vast majority of the 600,000 spine surgeries that take place in the United States each year are highly successful, decompressing nerve roots that are pinched or stabilizing painful spinal joints that have led to chronic pain, numbness or loss of function. But when back or neck surgery goes wrong, it can be devastating to both patient and surgeon, even if it’s statistically impossible for all surgeries to be effective.
“The amount of trauma, scarring, and hardware such as bone grafts and screws that are used in spinal surgery all factor into the chances someone may develop this condition,” explains Dr. Kadimcherla, who is fellowship-trained in orthopedic and spine neurosurgery. “Joints at the surgical site can also become inflamed, and scar tissue might form where a section of bone has been removed from the spine. In short, there are many reasons back or neck surgery can go wrong, so failed spine surgery syndrome is very difficult to totally prevent.”
Why might spine surgeries fail?
As a rule, spine surgeries are performed as a last resort when neck or lower back pain cannot be relieved by more conservative measures, such as medications or physical therapy. But at least 5% are left with lingering pain after an operation, Dr. Kadimcherla says. Symptoms may include back, leg or arm pain that is dull and aching; sharp, stabbing pain; and tingling, numbness or muscle weakness.
But why might spine surgeries fail? Dr. Kadimcherla offers these possible reasons:
- Residual disc herniation
- Recovery has created undue stress on another weakened portion of the spine
- Improper fusion after spinal fusion
- Misaligned spine hardware
- Incomplete bone removal
- Infection in a disc space
- Nerve damage
- Improper diagnosis of original problem
“Undergoing back surgery is rarely a decision patients take lightly or rush into, so when pain persists afterward it can be very distressing,” he says. “Yet, there are many viable options for improvement in these patients going forward. All is not lost if their back or neck surgery has been deemed a failure.”
Tips and hope for failed spine surgery patients
The first step toward relieving back or neck pain after a failed surgery is making sure a patient has the correct diagnosis, Dr. Kadimcherla says. This is done by using imaging tests such as X-rays, MRI or CT scans, and certain diagnoses can be confirmed with the help of procedures such as nerve blocks or other injections.
Once the reason for ongoing pain has been established, a multi-pronged approach for pain relief usually works best, Dr. Kadimcherla explains. Treatments can include:
- Physical therapy or exercise
- Psychological counseling
- Procedures such as epidural steroid injections or nerve blocks
- Spinal cord stimulation, a device emitting electrical pulses into the spinal region
Tellingly, however, one of the best options for treating failed back surgery is undergoing another surgery, but not an “open” procedure involving a long incision and recovery. Dr. Kadimcherla often recommends endoscopic spine surgery – a minimally invasive approach with boasting a rapid recovery – to those experiencing lingering problems after an initial procedure.
“Endoscopic spine surgery can represent a safer, less risky and less complicated solution,” he says. “I’ve treated many patients after spine surgery with residual symptoms with endoscopic nerve decompression, and I strongly feel a patient with failed back surgery syndrome can benefit from consulting with a doctor who’s an experienced endoscopic surgeon.”
“Obviously, someone who’s experienced failed spine surgery already has dealt with a less-than-optimal scenario,” Dr. Kadimcherla adds. “But with a correct diagnosis and proper treatment, pain can often be eliminated or very well managed. “When all else fails, make sure you don’t let a failed spine surgery have the last word.”
Presented on HealthNewsDigest.