Approximately 10-40% of back surgeries are unsuccessful. Even given the best surgeons and condition, there is a 5% chance that the spine surgery might not produce desired results. When a patient complains of persistent pain after a back surgery, we refer this condition as failed back surgery syndrome. The aim of back surgery can be any one of the following:
- To relieve the pressure from pinched nerve roots
- To stabilize a spine segment that shows abnormal movement
- To correct a deformity of the spine
Spine surgery only changes the anatomy of the painful spine aiming to remove the most likely cause of back pain. It does not directly cure the pain. This is why back surgeries can fail.
Main Causes Of Failed Back Surgery Syndrome
- Failed fusion of the spine
- Failed spinal implant
- Recurrent disc herniation
- Sustained nerve compression
- Unresolved nerve damage despite the surgery
- Pain in another spinal region
- A pain causing lesion missed from being operated
Before deeming the back surgery as “failed,” doctors will conduct certain tests to make sure that the problem cannot be corrected anymore with further back surgery. Tests can include MRI, CT scans, X-rays, EMG (electromyography) and nuclear medicine bone scans.
If the back pain continues many months after the surgery, doctors first try to determine whether there are any causes of the pain that can be fixed with one more surgery. Causes can be herniated disc, sustained nerve compression or failed fusion surgery. Additional surgery may correct these issues.
If another back surgery is not the right solution then doctor would suggest therapies like medication, physical therapy and surgical options.
- Anti-inflammatory drugs: aspirin, ibuprofen, acetaminophen, naproxen
- Narcotics: morphine, codeine, oxycodone, hydrocodone, fentanyl patches
- Neuromodulatory drugs: gabapentin, pregabalin, amitriptyline, duloxetine
Surgical Treatment Options
Getting steroid or anesthetic injected into the spine provides considerable pain relief. Steroids help reduce inflammation which in turn decreases the pain.
Spinal Cord Stimulation
It is a minimally invasive technique where stimulator implant is placed in the spinal canal. Patients get significant pain relief with spinal cord stimulator without having to deal with side effects that come with medicine. This option allows patient to control their device to a considerable extent.
Intrathecal Drug Infusion
Pain medication is continuously supplied directly into the spinal fluid with the help of pumps and catheter implants in this therapy. This way, the patient get very enhance pain relief from a low dose with no side effects such as drowsiness.