When you first discuss surgery with a Santa Monica spine surgeon, it’s perfectly normal to have expectations to reach a point where you can get back to doing the things that matter most to you without distracting pain. It’s also normal to have some discomfort as you go through the initial recovery period, which could last for several weeks or months, depending on your specific procedure. However, if it’s been a year since you’ve had spine surgery and you’re still experiencing back pain, it’s also understandable to wonder why. Here are three possible reasons.
1. Problems with Scar Tissue
The body naturally produces scar tissue as part of the healing process, which normally isn’t a problem unless this tissue forms close to sensitive nerve roots. This type of scar tissue is called epidural fibrosis, which is a fairly common occurrence following back surgery, even in patients with successful outcomes.
Scar tissue around nerve roots forms slowly, usually starting to appear 6-12 weeks after surgery, but there may be a period of initial pain relief before back pain or radiating nerve pain felt in the thighs or legs returns. One possible solution is to proactively stretch after surgery to minimize the risk of scar tissue forming. If epidural fibrosis does form and physical therapy techniques aren’t effective, treatment may involve:
• Percutaneous adhesiolysis – Steroid medication is injected into the affected area via a catheter.
• Spinal endoscopy – A scope is used to visualize the affected area. Lasers are sometimes used to break up the scar tissue while the scope is inserted.
2. Failed Back Surgery Syndrome (FBSS)
If it has been a year since your back surgery and you’re still experiencing symptoms similar to what you had before your operation, you may have what’s termed failed back surgery syndrome.
In some instances, discomfort may ease but there will still be lingering pain. If this happens, there may be a secondary source of nerve compression that wasn’t diagnosed. In rare instances, something that happens during the surgery itself causes injury to a nerve or instability in a nearby part of the spine. Possible solutions for FBSS include:
• Scar tissue removal
• Attempts at conservative (non-surgical) treatments (e.g. physical therapy, injections, electrical nerve stimulation techniques like TENS) after the source of ongoing back pain is diagnosed*
• Revision spine surgery
*Another option is to explore alternative treatments that provide sufficient relief, such as chiropractic care and acupuncture.
3. Fusion Fails to Form
As the most common type of spine surgery performed in the United States, fusion surgery has a fairly high success rate. Even so, there are times when the bone graft material doesn’t fully form new bone tissue. In some cases, the problem is something called adjacent-segment disease, which means the fusion was successful but a vertebra above or below the surgical site is now unstable. Fusions may also fail for the following reasons:
• Excessive motion around the affected area of the spine (e.g. becoming too mobile, too soon)
• Improper hardware placement
• Overusing anti-inflammatory drugs (which sometimes inhibits fusion formation)
Various forms of physical therapy may ease symptoms that occur or continue when a fusion fails to form. However, revision surgery is the most common solution.
There is no way to guarantee spine surgery will leave you free of back pain or related symptoms a year later. However, you can go into spine surgery with realistic expectations, actively participate in physical therapy, and take appropriate precautions to avoid overstressing your back as it heals. It can also be helpful to honestly communicate with your doctor as your recovery advances so concerns such as unusual or returning pain can be addressed as soon as possible. There are a variety of spinal procedures that can alleviate back pain, from XLIF to ACDF. Santa Monica patients can call The Spine Institute today at 310-828-7757 to determine if surgery is their best option for finding relief.