As a leading cause of chronic discomfort, inactivity, and work limitations, back pain is one of the most common physical complaints in the United States. Back pain is so common, in fact, that an estimated 75-85% of American adults experience it at some point in their lives.
When back pain is so severe or persistent that conservative measures, such as weight reduction, physical therapy, and epidural steroid injections, are insufficient or ineffective, many people turn to surgery in a final bid to attain lasting relief.
While spine surgery aims to be a curative solution for severe cases of back pain, some people experience continued discomfort following their procedure. Known as failed back surgery syndrome (FBSS), this unpredictable phenomenon is a frustrating experience for patients and surgeons alike.
Read on as fellowship-trained neurosurgeon Jose Valerio, MD, discusses the most common causes of FBS, and how you can reduce your risk of facing it following back surgery.
Understanding failed back surgery
Failed back surgery simply means that a patient continues to experience persistent neck or back pain following spine surgery. Pain may be immediate, it may emerge months after the procedure, or it may occur alongside other neurological symptoms, such as numbness, tingling, and weakness.
Although this unwanted result is generally referred to as failed back surgery syndrome, the term is a confusing misnomer: Unresolved or new pain following back surgery is not a syndrome, and it doesn’t mean the surgeon, or the patient, did something wrong to cause it.
Recently, an international group of neurosurgeons and back pain specialists proposed a more cohesive and accurate clinical term for continued pain following spine surgery: persistent spinal pain syndrome (PSPS).
What might cause failed back surgery?
All spine surgeries aim to accomplish one of three goals: decompress a pinched nerve root, stabilize a painful joint, or both. In most cases, FBSS doesn’t mean spine surgery was “botched” or performed incorrectly, it simply means the procedure was ineffective or didn’t achieve the desired outcome.
Although it’s not always possible to determine the cause of FBSS, some of the most common reasons for pain after back surgery include:
Misdiagnosis of pain
A primary cause of FBSS is the misdiagnosis of pain prior to surgery. You may experience continued pain after spine surgery if the lesion that was operated on isn’t the primary source of your pain.
It’s not always obvious which structural problem or injury (lesion) is at the root of persistent pain. This is because many spine conditions share similar symptoms, affect multiple body areas, and cause referred pain, all of which can make it harder to reach an accurate diagnosis.
Non-union of a spinal fusion
Spinal fusion and SI joint fusion surgeries don’t instantly fuse the vertebrae of your spine. During surgery, bone grafts and stabilizing hardware are used, but it takes time for new bone tissue to develop and for the vertebrae to fuse.
If the bones don’t fuse properly (pseudoarthrosis), it can ultimately cause renewed spinal destabilization and pain as the hardware loosens.
Sometimes, successful back surgery leads to post-operative pain in unexpected ways. With adjacent segment disease (ASD), a successful spinal fusion causes a redistribution of abnormal load burdens to adjacent spinal structures, causing them to degenerate more quickly. Pain typically reemerges years down the road.
Stressful load burdens and overcompensation by adjacent areas of the spine can also lead to poor biomechanics, a common cause of chronic back pain, tension, and muscle spasms.
The objective of spinal decompression surgery is to take pressure off spinal nerves that are being pinched by a herniated disc or spinal stenosis. While creating too much space around the nerves can lead to spinal instability, failing to create enough space can lead you right back to the original pain problem through recurrent disc herniation or spinal stenosis.
Excessive scar tissue
Scar tissue formation is a normal part of the healing process following any type of surgery. In some back surgery cases, however, the body forms excessive amounts of scar tissue around the surgical site that may bind to nerve roots in the spine, leading to a painful and common FBSS condition called epidural fibrosis.
How can I prevent failed back surgery?
Many of the factors that lead to FBSS can be unpredictable and out of anyone’s control. Still, there are a few proactive steps you can take to reduce your risk of developing FBSS following back surgery.
First, and foremost, ask questions. When in doubt, seek a second or even third opinion. An experienced and respected neurosurgeon won’t recommend back surgery if it isn’t likely to resolve your problem or they can’t pinpoint the source of your pain with accuracy.
Second, know your personal risk factors for FBSS, and if you can, try to address them before you have spine surgery. People who are overweight, use tobacco, struggle with depression, or have an existing chronic pain condition, such as fibromyalgia, carry a greater risk of experiencing persistent pain after back surgery.
Third, ask more questions so you know what to expect following surgery, including what kind of discomfort you can expect as you heal, and how long you should expect to have it. Follow your postoperative instructions exactly, and make post-surgical physical therapy a top priority.
To learn more or schedule an appointment with Dr. Valerio, call your nearest office in South Miami, Hialeah, or Weston, Florida, today.