Failed back surgery syndrome is a term that surgeons do not like at all for many reasons. This syndrome refers to the persistence of low back pain after surgery or the appearance of pain after the surgery. It may not be a very successful term but it describes a situation that is not uncommon. The studies speak of a frequency between 20 and 40% of this syndrome.
Why does back surgery syndrome occur?
If a person does not resolve their pain or gets worse after surgery, something has happened. What has happened? There is not a single answer to this question but there are factors to analyze.
The indication: Was the surgery necessary? Was it appropriate to practice? Lumbar spine surgery has a limited capacity. He is able to basically get two things. On one hand, surgeries are performed to give space to a nerve root that is suffering. On the other hand, a disc segment that is producing symptoms is immobilized. This is basically what surgery does. If it is not refined in the cause of pain, it can be operating something that is not.
The problem is that back pain is not so simple; there is rarely a purely anatomical explanation. If a herniated disc is pinching a nerve and producing sciatica, the result will be good because the problem is clear. If we have low back pain and see a hernia, the thing is not so clear. The hernia we see many times is the consequence of what does not work and not the cause of the pain.
The patient: When we talk about the indication to operate, it is not only important to detect the source of the pain. When choosing to operate also have to take into account if the person is the right one to operate. Anesthesiologists visit the patient and make sure they will survive the surgery. If they see the risk is too high they will not let you have surgery. But there is something that is not usually valued and is the psychological or psychiatric situation of the patient. Without getting into complex diseases, something as common as anxiety and depression may be the indicator that the results are going to be bad.
Lifestyle: It’s not all the fault of the surgery itself. It seems a topic but it is scientifically proven that smoking goes against success in a back surgery, especially in arthrodesis. The good news is that if we stop smoking before entering the operating room, the results are close to those of non-smokers. People with obesity have major complications after surgery.
The surgery itself: In an earlier post I explain the reasons for low back pain after surgery (leave link). The intervention itself causes low back pain and requires a recovery process to resolve the pain. In addition we have the complications that can arise as in any surgery and that can hinder an adequate recovery. The epidural fibrosis is one of the factors most diagnosed as a cause of failure in surgery. The pain that arises after the intervention must be evaluated. Sometimes it can suggest an error or a new problem that requires a solution such as a hematoma or an infection.
What do I do if I have a failed back surgery syndrome?
What seems clear from the studies there is that the situation will rarely be improved with a new surgery. The exception to this is complications that require surgery such as bleeding that compresses nerve roots or damage to these roots due to hernia recurrence. Surgery should be the last option to resolve a poor surgical outcome unless there are complications that recommend it.
The basis of treatment will be physical therapy and medication. Sometimes techniques such as epidural infiltration or the release of adhesions are used percutaneously to improve pain. Also more palliative techniques such as radiofrequency or neuromodulation.
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