When patients come to my practice after back surgery, they are often disheartened because they have gone through a massive operation in the hopes that it would cure their underlying issue and leave them pain-free. The reality is much different. Many continue to have pain or develop new back pain, neck pain, or sciatica. Back and neck conditions are often chronic. Instead of thinking in terms of cures for these conditions, we should be thinking in terms of treatment and management, just like with high blood pressure or diabetes. It’s important to realize that the spine can be treated and managed, but not cured. Doctors can only treat functional abnormalities of the spine that cause pain. Surgery is usually performed as a last resort; there is often a mechanical disruption of the internal milieu of the spine.
Spinal Structure
In understanding the mechanics behind back pain, it’s important to understand the structure of the spine. The spine is made up of many parts, with the main structures being vertebrae, which are the bones within the spine. These are separated by what can be called, in simple terms, discs, which act as shock absorbers. There is also the spinal canal, which protects two other structures, the spinal cord and the nerves that run through the spine. The nerves become susceptible to injury in the central canal. When these nerves exit the spine, they go to the periphery of the body, the arms, and legs. When there is a disruption of the spine’s internal structures—such as the discs, which can bulge out and push against a nerve—a patient can have back pain or sciatica.
Symptoms of a Failed Spinal Surgery
When back pain or neck pain with associated symptoms such as sciatica is severe and not well-managed by other forms of treatment, there can be a form of neurological dysfunction associated with them. This can be a loss of bowel or bladder control, or perhaps something known as a foot drop or lower extremity weakness or numbness. Surgeons will often decompress or stabilize the area that’s causing the pain in the hopes that this will reduce a patient’s level of pain.
Other times, surgery is done to stabilize the spine and prevent further injury, most commonly seen in the neck or the cervical spine when a patient has a condition called cervical spinal stenosis. Doctors perform surgery when there is instability in the lower spine causing one spinal bone or segment to move forward or backward over another, compromising the nerves that run through the canal. Spine surgery can be very beneficial in this case to prevent further damage and prevent neurological injury, but it does not always guarantee that a patient will have pain relief. Therefore, patients are extremely disheartened when the surgery either does not take care of their pain or results in the development of new spine-related pain sometime after the surgery.
Spine surgery does not typically fail because the surgeons do a poor job. After spine surgery, the physician can look at the imaging, and everything can look correct, but that does not necessarily translate to a pain-free or reduced pain state. Unfortunately, another issue is that reasonable expectations are often not discussed in advance of surgery, leaving patients to believe surgery will cure the problem and come out pain-free when this is not always the case.
Alternatives to Spine Surgery
Spine surgery can decompress a nerve root that is pinched or stabilize a painful joint. It’s important to realize, though, that most episodes of back pain or sciatica can successfully be managed without surgery. Treatment includes physical therapy, medication management, and minimally invasive procedures such as epidurals and radio frequency, ablations, or other procedures to treat underlying back pain and sciatica.
The bottom line is this: patients must have realistic expectations, and surgery must reserve surgery as a last resort. Patients must also realize that they may still need ongoing pain management. Interventional pain management specialists diagnose and treat causes of neck pain, back pain, and associated symptoms such as sciatica. Many patients can survive and live with a significantly reduced level of pain—and, yes, sometimes even pain-free—with the help of an interventional pain management physician. Before considering surgery, or if you are experiencing complications and ongoing or new pain after back surgery, please seek out a board-certified pain management physician who can accurately diagnose and treat your pain.
