By the time people reach midlife, more than half of them will experience significant episodes of low back pain. That’s how common low back pain is, and because of the prevalence, low back pain often leads to surgery. The surgery may give the back pain sufferer some relief, but many continue to experience a significant amount of pain. You may wonder, if surgery was done to stop the pain, then why would there still be pain after the surgery to relieve it? Back surgery requires the removal of some of the structures of the spine that help to stabilize the spine. So when they are removed, the spine will be weakened. Also, in surgeries that involve fusion of the spinal vertebrae, the areas above and below the fusion often degenerate, since movement needs to occur somewhere. The various back surgeries alter the spinal dynamic and make the patient more susceptible to new pain. Unfortunately, ten to forty percent of lower back surgeries for disabling pain end up in the person needing repeat surgery due to ongoing pain. New or persistent back or leg pain after back surgery is a condition known as Failed Back Surgery Syndrome. The numbers are so overwhelming that this condition has its own diagnosis.
A Little Background on Low Back Pain
The lumbar spine is composed of five vertebrae separated by discs and supported by strong muscles and ligaments. Cumulative trauma through years of certain activities or sports can result in small tears of the ligaments. If a major trauma transpires, the injury to the ligament can be of such severity that ligament healing never occurs, leaving the vertebrae unstable and without the support they need. The instability and ligament laxity cause ongoing low back pain. This pain is what sends people by the droves to orthopedic surgeons. If the back pain leads to back surgery, important muscles and ligaments are cut, adding to an already unstable lumbar structure.
Explain What Failed Back Surgery Syndrome Involves?
A back surgery may be considered “successful” by the surgeon just because the anatomic area was surgically “fixed correctly.” However, the patient may still suffer from Failed Back Surgery Syndrome, and continue to experience the defining symptoms which include persistent back and/or leg pain. Pain that occurs right after surgery is often due to sensitized nerves. Many nerves have to be cut by the surgeon in order to get to the area of the vertebrae being repaired, and sometimes those nerves become inflamed and/or compressed. In cases where the post-surgical pain becomes chronic and ongoing, the pain is often from spinal instability from causes which may include the removal of too much bone or due to damage to the spinal ligaments. Any time surgery is performed on the spine, it will alter the mechanics of the spine, and this will result in more force being generated at and around the areas where the surgery is done.
The pain and discomfort of Failed Back Surgery Syndrome (FBSS) cause a major negative impact on the ability of those with the syndrome to manage everyday life activities such as standing, lifting and traveling. Physicians see many patients who have had back surgery or multiple surgeries who continue to have pain. Sometimes the surgery fixes the pain for a year or so, but then the pain returns. The individual who had the surgery is both terrified about going through another surgery, and is also afraid of the prospects of living in pain and on pain medication.
With so much progress technologically, how does FBSS still happen?
Sometimes surgery is done when it was never indicated. Surgery may be recommended based on MRI findings primarily and not after a thorough history and review of symptoms to match up to the MRI. This results in performing surgery on a structure that looked bad on MRI, but which was actually not the true cause of pain.
While operating on one condition, another condition may be overlooked. A disc may be removed, for example, but the underlying instability, causing disc degeneration and stenosis were not addressed. If the issue causing the problem in the first place is never addressed, disappointing results and pain will result. Wrong spinal levels may even be operated on. Failed Back Surgery Syndrome may be the result of outright inappropriate surgeries, inadequate surgeries where the underlying pathology is not addressed, or even unnecessary surgeries.
Failed Back Surgery Syndrome may result after fusion surgery. Once the joints are fused together, motion in the spine has to come from somewhere else, creating added stress on the sections above and below the spine. It is then only a matter of time before arthritis and pain develop in the adjacent segments.
Fusion surgery is recommended because there is too much movement or instability in the spine. The surgeon is looking to place artificial material to permanently fuse the area together, to keep it from moving. But this doesn’t always resolve the pain, and will eventually cause degeneration at the levels below and above the fusion, frequently leaving the back pain sufferer with more back pain and arthritis because of the surgery.
How Is Failed Back Surgery Syndrome Treated
Patients with Failed Back Surgery Syndrome experience prolonged pain and because of that treatment often includes narcotics, steroids and even anti-depressants, since the prolonged pain often results in depression. All of these medications come with their own set of problems. Spinal cord stimulation is also utilized and allows for some relief in a subset of FBSS patients with radicular leg pain. These patients, however, continue to experience difficulties in function and quality of life.
Regenerative Orthopedics Help with Failed Back Surgery Syndrome
Regenerative Orthopedics refers to therapies that stimulate the body to heal itself, such as Stem Cell Therapy, PRP, and Prolotherapy. These regenerative injection therapies stimulate the body to repair, without the need for surgery. Our bodies have amazing regenerative capabilities. This is a novel approach because we are triggering the body to strengthen the tissue on its own, without the use of artificial hardware.
For those patients who are taking narcotics, or for those with spinal cord stimulators, an initial consultation to discuss these treatments would be recommended. Regenerative Orthopedics therapies resolve the problems that damaged the spine, and for optimal healing, other therapies that are suppressing the ability of the body to heal need to be limited or stopped. Regenerative Orthopedic therapies are reparative treatments and are alternatives to surgery. They can also help when surgery has already been done, but failed to address the root issue.
For those with back pain who have not had surgery yet, we strongly recommend looking into regenerative therapies first. One of the wonderful things about Regenerative Orthopedics for back pain is, the individual can maintain activity and get back to the activities they enjoy, without the need for extensive downtime. Treatments and exercise programs are individually tailored to promote healing and return people to their active lives. It’s really an amazing transformation to see people regain their mobility and independence!
Regenerative Orthopedics is helpful for almost all types of back pain: herniated discs, bulging discs, degenerative disc disease, chronic subluxation of the sacroiliac joints, and more. Regenerative Orthopedics may save you from an unnecessary surgery, because the treatments address the problems causing the instability, and offer a way of repair when other treatments often fail.
Regenerative Orthopedics treatments correct the underlying problem of spinal instability. Without this correction, the patient is more likely to continue on the course of pain and symptom chasing pain management therapies that only temporarily calm the pain. Remember, spinal instability is a progressive disorder, meaning that the area will continue to degenerate until regenerative treatments are used to restore them.