Back Pain - Topics

While spinal surgeons boast of 98% success rates, internet forums are full of patients whose back surgeries have failed. Surgeons generally do not measure success by the amount of pain reduction experienced by the patient.

Failed back surgery syndrome (FBSS) is the term given to symptoms of back and leg pain experienced after back surgery has been performed to treat them. Pain may be as intense as or worse than before surgery.

The most common types of spinal surgery performed today are discectomy and spinal fusion. During a discectomy operation, the surgeon removes a portion of a spinal disc that was bulging or herniating, causing nerve irritation. Fusion surgeries entail the removal of a disc and the fusing of two vertebrae together. This is performed either by the use of rods and screws or bone grafts. The purpose of fusion is to immobilize a section of the spine that was causing painful instability.

A number of things can go wrong during back surgery. Before you can treat your FBSS, you need to know what is causing the pain. One of the most common residual results of surgery is the formation of scar tissue. This is a natural part of healing, and often causes no pain whatsoever. If the scar tissue becomes bound up with nerves around the spine, however, it can cause nerve pain. Light stretching may be enough to prevent scar tissue from binding to nerves. Scar tissue generally develops during the first three months after back surgery.

Another common cause of postoperative pain is stenosis. The spinal canal houses the intricate bundle of nerves called the spinal cord that exits the spine. This canal can become narrower in certain areas by the protrusion of bones or discs. A disc can bulge into the canal as a result of being tampered with during discectomy or microdiscectomy. The spine is composed of a number of structures in a small space; the slightest error on the surgeon's part could disrupt the anatomy. Stenosis impedes nerves and leads to nerve pain.

After a fusion or discectomy, the discs that remain are forced to absorb more shock than before, since one of the spine's shock absorbers has been removed. This can lead to painful conditions in the discs surrounding the area of surgery, such as bulging, herniation or degeneration.

Another possible factor of FBSS for those who had spinal fusion surgery is failed fusion. If the hardware fails or if the bone graft is rejected by the body, the vertebrae will not grow together. This can lead to further destabilization and painful friction between the bones.

The cause of your postoperative pain can usually be determined by examination and MRIs or CT scans. Unfortunately, the treatment for some of these causes of FBSS is re-operation. There are alternatives that can be attempted before risking another failed back surgery. Physical therapy is generally recommended for people who have had successful back surgeries to help them recover. Those whose surgeries failed need physical therapy even more. Depending on the cause of your pain and the type of operation you had, a physical therapist will prescribe specific exercises and stretches that are safe for you to perform with the goal of easing pain. These professionals can also help you to retrain your posture and movements to limit pressure on painful areas in your back.

Pain medications are prescribed en masse for postoperative pain. If your pain ends up being chronic, it is important to find another form of pain management. Initially, it may be necessary to numb the pain in order to pursue exercise therapy. Epidural steroid injections are commonly prescribed. Other more intense forms of medicating include spinal cord stimulation and pain pump implantation.

If back surgery has left you worse off than you were before, you need to carefully consider treatment options. Educate yourself as to the cause of your pain and pursue conservative methods first. Learn more about different types of FBSS here: http://www.pmrehab.com/fbss.htm.