As one of the most common physical complaints among adults in the United States, back pain is a leading cause of chronic pain, inactivity, disability, and work limitations. Nearly 65 million Americans report a recent episode of back pain, and an estimated 75% to 85% of adults will experience it at some point in their lives.
When back pain becomes so intense or persistent that conservative solutions like weight reduction, physical therapy, chiropractic care, and epidural steroid injections no longer help, many people turn to spine surgery in a final bid to attain enduring relief.
Unfortunately, back surgery isn’t always the curative treatment it aims to be — some people still experience function-limiting pain following their procedure because of an unpredictable and frustrating phenomenon known as failed back surgery syndrome (FBSS).
At The Rehab Docs in Daniel Island, South Carolina, our skilled team of experts specialize in postoperative rehabilitation. Here, Kevin Bein, DC and Sam Sheppard, PT, DPT, TPI discuss the most common causes of pain after back surgery and how you can address it.
Before you explore the common causes of pain following back surgery, it’s important to define the widely used term for this problem: failed back surgery syndrome.
FBSS simply means that a patient continues to experience persistent pain after back surgery. It may emerge right away or months after the procedure; it may be a lone symptom, or it may be accompanied by other neurological symptoms like numbness, tingling, and weakness.
While this kind of result is frustrating and unwanted, unresolved or new pain following back surgery is not a syndrome, and it doesn’t mean the surgery itself was a failure. It also doesn’t mean that the surgeon or the patient did something wrong to cause it.
In recent years, an international consortium of neurosurgeons and back pain specialists put forward a more succinct and accurate clinical term for continued pain following back surgery: persistent spinal pain syndrome (PSPS).
Every back surgery procedure has one of three possible goals: to decompress a pinched nerve root, stabilize a painful spinal joint, or both. When pain still occurs following surgery, it usually means the procedure was ineffective or simply didn’t achieve the desired outcome.
The leading reasons for pain after back surgery are:
One of the most common causes of back pain after surgery is the misdiagnosis of pain prior to surgery. It’s not always completely clear which specific structural problem or injury (lesion) is at the root of persistent back pain. When surgical treatment isn’t based on an accurate diagnosis, the operation can’t address the real problem.
Decompression surgery takes pressure off spinal nerve roots that are being compressed or pinched, usually by a herniated disc or spinal stenosis. While creating too much space around the nerves can cause spinal instability, not creating enough space can lead to recurrent disc herniation or stenosis — and renewed pain.
Spinal fusion surgery fuses the vertebrae of your spine to create needed stability. This process takes time, however: The placement of stabilizing hardware helps create immediate stability, while the addition of bone grafts promotes new bone growth and helps the adjacent vertebrae fuse naturally over time.
When the bones don’t fuse properly (pseudoarthrosis), the stabilizing hardware may loosen and lead to renewed spinal destabilization and pain.
After any type of surgery, your body forms scar tissue as it heals. Following back surgery, some people’s healing mechanisms go into overdrive, prompting the formation of excessive amounts of scar tissue around the surgical site. If this overabundance of scar tissue binds to nerve roots in the spine, it can cause a painful postsurgical condition called epidural fibrosis.
In some cases, an apparently effective back surgery leads to new and unexpected pain years down the road. This is often the case with adjacent segment disease (ASD), which happens when a successful spinal fusion shifts abnormal load burdens to adjacent spinal structures, causing them to degenerate more quickly. Unbalanced load burdens can quickly lead to poor biomechanics, a common cause of chronic back pain, tension, and muscle spasms.
It’s important to understand what to expect following back surgery, including what kind of discomfort you may experience as you heal, and how long you might have it. It’s also very important to follow postoperative instructions exactly and make postoperative rehabilitation your top priority.
If your pain persists, our orthopedic diagnostics experts can assess the physiological changes caused by the surgery, and develop a responsive, multidisciplinary treatment plan to address the underlying factors that are contributing to your pain.
At The Rehab Docs, physical therapy (stretching, strengthening, and conditioning exercises) and chiropractic treatment (spinal adjustments and soft tissue massage) are central to our holistic rehabilitation approach.
To find out how we can help you overcome postsurgical back pain, call 843-749-8848 today, or use our easy online booking feature to schedule a visit anytime.