Back pain can range from the occasional mild to chronic debilitating. Most back pain gets better on its own within a few months. In many other cases, it can be treated non-surgically with options such as physical therapy, medication, and conservative minimally invasive procedures.
However, while major back surgery is rarely necessary, it may be warranted in some cases. This includes medical emergencies and situations in which symptoms significantly disrupt quality of life. Different types of major back surgery include diskectomy, laminectomy, fusion, and artificial disks.
A 2023 paper published in the American Journal of Lifestyle Medicine estimated that 60% of initial back surgeries in the United States were successful. This leaves a significant percentage that don’t work out.
What Is Your First Step If You Continue to Have Pain After Major Spine Surgery?
You should seek emergency care or call your doctor if, after major back surgery, you experience:
- Signs of Infection: You experience a fever of 101°F or greater, or observe increased redness, swelling, warmth, or pus around your surgical incision.
- Neurological Changes: You have new or worsening numbness, tingling, weakness, or pain in your feet, legs, or arms.
- Loss of Control: You have difficulty urinating or having a bowel movement.
- Other Severe Symptoms: You have chest pain, difficulty breathing, or your surgical incision opens.
But your first step, if not an emergency, is to visit your spine surgeon if you continue to experience pain months after surgery. They can evaluate your spine and check for potential complications from the surgery. This may include infection, hardware issues, scar tissue compressing nerves, adjacent segment degeneration, or failure of a fusion to heal.
However, even when there aren’t obvious complications from spine surgery itself, back pain can continue to persist. Why?
Back Pain Often Stems from a Variety of Issues, Not Just One
For many patients, it’s a mistake to believe that back pain is the result of a singular cause. A combination of different causes can wear down the spine and supporting tissues over time. It follows that even if major back surgery addresses one source of back pain, other issues will remain after the procedure.
Back pain can stem from a variety of issues, including:
- Muscle/Ligament Strains: from injuries or overuse.
- Structural Problems: arising from degenerative discs, spinal stenosis, or spondylolisthesis.
- Lifestyle issues such as being overweight, physical inactivity, poor posture, smoking, and stress.
- Underlying Conditions: including arthritis, osteoporosis, infections, or referred pain from other organs.
Thus, even after major spine surgery, alleviating back pain is often a journey that will involve additional treatments and rehabilitation steps. Often, nonsurgical or minimally invasive options can be effective to that end.
Major Spine Surgery Can Lead to Other Issues
Major spine surgery can also create new issues, complications, and sources of pain, which can prolong recovery and, in some cases, necessitate revision. These may include:
- Adjacent Segment Disease (ASD): This is a condition that sometimes occurs after spinal fusion surgery. During this surgery, two or more bones are joined or “locked” together, stopping the natural motion at that spinal level. This can increase stress above and below the fused area, accelerating degeneration and causing new pain.
- Nerve Damage/Injury: During spine surgery, there is a risk of nerve injury from accidental trauma, inflammation, or compression. This can lead to numbness, tingling, weakness, or new pain.
- Infection: All surgery carries the risk of infection, which can cause swelling, pain, and systemic symptoms.
- Hardware Problems: The screws, rods, or plates used in some spine surgery procedures can break, loosen, or become dislodged. This often causes persistent pain, tingling, numbness, weakness, or instability because the implants either fail to fuse the bones or irritate nerves.
- Scar Tissue (Epidural Fibrosis): Scar tissue, or epidural fibrosis, is a natural healing response that can occur after spine surgery. This is where dense fibrous tissue forms around nerves, potentially compressing them and causing pain, numbness, or weakness. This can happen even after a technically successful surgery.
- Spinal Instability/Deformity: After major spinal procedures, such as a laminectomy, spinal instability and deformity may occur. This may involve abnormal spinal movement or worsening curvature (like kyphosis) due to structural changes (muscle weakness, bone removal), increasing pain, disability, or neurological issues.
- Sagittal Imbalance: After spinal surgery, the spine’s natural front-to-back curve may be disrupted. When that happens, it can affect posture and often cause pain.
- Persistent Spinal Pain Syndrome: Persistent Spinal Pain Syndrome is a general term for persistent or new pain after surgery, often due to the complications discussed above. Sometimes “Failed Back Surgery Syndrome (FBSS)” is also used as a general term for these issues. However, Failed Back Surgery Syndrome is more appropriately used more narrowly to describe back pain after major lumbar disc herniation surgical procedures.
Detailed Diagnostics is the Best Action Plan if You Continue to Have Back Pain After Major Spine Surgery
We are all continually bombarded with ads promoting one treatment or another as the “magical cure-all” for our back pain. The reality is, as we’ve just reviewed, the causes of back pain are incredibly varied and complex – and often involve multiple simultaneous issues. To pursue any specific treatment without first specifically identifying the cause(s) is folly.
Although some medications and supplements can help lessen back pain and reduce inflammation and swelling, the results are temporary. These medications and supplements don’t “cure” what’s causing the pain in the first place.
We’ve also discussed that while major spine surgery may alleviate one source of back pain, other sources of pain may persist. For example, even though you may have had spinal fusion surgery, you still may have vertebrogenic pain in one or both of the fused vertebral endplates. In such cases, a skilled physician can treat this condition in a brief outpatient procedure.
Your best action plan is grounded in in-depth diagnostics. You can’t determine an appropriate treatment path without first identifying the cause(s) of the pain. Given the complexity of our musculoskeletal and nervous systems, arriving at an answer often requires a disciplined, multistep process.
A Physical Medicine and Rehabilitation Physician is usually a good option to visit to guide you on this diagnostic journey. They are known for their focus on providing a big-picture view for patients with complex needs. Also known as Physiatrists, PM&R doctors employ a broad range of diagnostic and treatment options, from nonsurgical to minimally invasive procedures, as appropriate. Their specialty also includes orchestrating and coordinating complex treatment plans across multiple providers, from physical therapists to orthopedists, as well as many other specialists in between.