PERSISTENT PAIN FOLLOWING BACK SURGERY Back Pain

UNDERSTANDING YOUR PERSISTENT PAIN

If you are still experiencing pain following your back surgery don’t despair.  Learn about the possible causes of this pain and what you can do about it.

• Failed Back Syndrome
• Epidural Fibrosis
• Problems Following Treatment
• Recurrent Stenosis after Decompression
• Inadequate Decompression of a Nerve Root After Surgery

FAILED BACK SYNDROME

Despite careful diagnosis and a successful operation, some patients may still experience pain after their back surgery. This persistent pain or continuation of symptoms is known as failed back syndrome (sometimes called failed back surgery syndrome), and it can affect your ability to complete daily tasks. The failure is not of the surgery itself, as the goals of the surgery, which may include decompression and stabilization, may have been achieved. The failure is to achieve complete resolution of symptoms.

Several factors affect the outcome of spine surgery. One possibility is that the spinal anatomy that was operated on was not the only cause of the pain. Sometimes the main problem has not been adequately addressed. In rare cases there may also be damage from the surgical procedure itself that is causing pain.

When back surgery does not help to relieve your pain or leads to new pain, it’s easy to feel discouraged. The good news is that there may be another treatment option: chronic pain therapies.

EPIDURAL FIBROSIS

The formation of scar tissue after back surgery is part of the normal healing process. Scar tissue pain is highly unusual because scar tissue itself has no nerve endings to cause pain.

However, epidural fibrosis, the formation of scar tissue near the nerve root, can put pressure on the nerve roots and thereby cause pain. Typically, symptoms associated with epidural fibrosis appear about 6 to 12 weeks after back surgery. Sometimes patients experience good pain relief early on after their surgery, but as the scar tissue slowly forms, the pain relief diminishes, and leg and back pain recurs or increases. Occasionally the nerve damage from the original cause of the patient's pain makes the nerve heal more slowly. Burning pain, or a constant gnawing pain that does not change with position, can be suggestive of scarring around nerves.  Postoperative stretching exercises can help decrease the effects of postoperative scarring around the nerve root.

PROBLEMS FOLLOWING TREATMENT

In a decompression surgery, such as a laminectomy or discectomy, the nerve root can take a long time to heal, making it difficult to gauge the outcome of the surgery right away.

Around three months after surgery, one of two outcomes may start to become apparent: 

• In general, patients who are getting better within three months of the surgery will continue to improve. 

• Patients who have not noticed any improvement approximately three months after the decompression are unlikely to receive substantial benefit from the surgery. 

It usually takes far longer for symptoms of numbness/tingling or weakness to resolve, and sometimes it can take up to a year for these symptoms to subside. If these symptoms persist after a year, it is most likely permanent nerve damage and is unlikely to get better. Each patient's post-operative experience may vary.  It is important to follow all instructions after your surgery, and to talk with your doctor about any symptoms you may be experiencing.

RECURRENT STENOSIS AFTER DECOMPRESSION

Years after a laminectomy, spinal stenosis can come back (the bone can grow back and narrow the spinal canal) at the same level, or a new level, causing back or leg pain.

INADEQUATE DECOMPRESSION OF A NERVE ROOT AFTER SURGERY

Decompressing a nerve root with back surgery is not always successful, and if a portion of the nerve root is still pinched after the back surgery, there can be continued pain. If this is the case, there will usually be no initial pain relief following the back surgery, and the spinal stenosis may still be seen in imaging in a portion of the spine.  If you’re experiencing pain after decompression surgery, there may be another option that can help relieve your pain.