Why Do Great Spine Surgery Results Often Turn Bad Over Time?

If spine surgery is done for the right reasons, the initial result may be fantastic. For instance if the patient has a herniated disc and exhausts conservative treatment then a discectomy procedure may give excellent results very quickly.

Studies actually show that results after a discectomy are well over 90% excellent. But what about those patients that have a great result initially and then those results deteriorate over time? Why does that happen?

Result deterioration occurs for a number of reasons. First reason to mention is that if surgery is done around a nerve root and it is decompressed surgically, scar tissue may end up enveloping the nerve root and cause damage which can lead to patients having significant pain. The scar tissue that grows around the nerve roads can be removed but more scar tissue will come right back. So another surgery is not always the answer.

It can be very frustrating for patients as it is not so easy to get a great spine surgery result, the patient had one, and then disappeared. The "cherry on top" frustration is that another surgery will not fix the problem, so the person may need interventional procedures such as epidural injections and maybe a spinal cord stimulator. A spinal cord stimulator does not fix the problem causing the pain, but if it cannot be fixed why not mask the pain?

An additional reason for pain to return is adjacent segment instability after a spinal fusion. When a spinal level is fused, the bones are welded together. The disc between the bones that used to absorb shock can no longer do that, so those stresses either go up or down to adjacent spinal levels.

Pain can begin to get worse from the arthritis and degeneration of the disc occurring. This may end up leading to another spine surgery becoming necessary. Unfortunate but commonly seen. This is unavoidable, as spinal fusion for certain conditions is the gold standard. If it's performed, the incidence of adjacent segment degeneration approaches 20% within a few years, and about 1/4 of spine surgery patients will need an additional procedure within 5 years of the first one.

It is very important that spinal surgery be done the first time for a good reason. The reason is that even if initial complications are avoided, subsequent longer term issues may very well arise. At that point additional surgery may or may not be indicated. Obtaining a second opinion regarding pain relief is never a bad idea.