Still having Pain after Spine Surgery?

Still having Pain after Spine Surgery?

Still having Pain after Spine Surgery?

0

Statistically,  most people do improve with spine surgery.  Unfortunately,  some people do not improve,  and a few are worsened.

As a Spine Surgeon,  I know many patients want a guarantee of improvement after surgery.   The truth is, THERE CAN NEVER BE A GUARANTEE.  Surgeons can only give chances of success.  As I tell my patients,  you have an X percent chance of improvement after surgery.  I will also let you know my definition of improvement is based on how you are feeling before  surgery.    If your pre surgery pain level is 8/10 or more,  and your after surgery pain is 3/10 or less,  that is an improvement.  As a surgeon,  I would consider that an excellent improvement.  Prior to surgery,  I would counsel you that the goal of surgery is a reduction of pain by 60%.   Because your expectations are properly set,  you should be satisfied with a pain level of 3/10 or less.    If your expectation was to be pain free,   you will be disappointed,  and may even feel you are worsened,  as it does not meet your expectations.

Beyond disappointments due to lack of proper expectations,  there are other reasons why some Spine Surgery is not successful.  Let’s just look at the most simplest of spine surgeries,  the standard Lumbar Discectomy.

For properly selected patients,  there is an expectation that greater than 90% will improve after surgery.  For the 5-10% that do not improve,  the reasons why can be difficult to identify.  A small percentage of patients do have postoperative complications such as infection,  or medical complications due to their heart,  or lungs.  Let us assume we have ruled out those reasons for a poor outcome.  The general reasons people do not improve are the following:

  1. Residual pressure on the nerves by other disk fragments or bone spurs.   Often times large fragments of disk herniations are removed,  but there can be additional fragments that may not be visualized.  For some patients,  there can also be narrowing of the space for the nerves secondary to bone spurs that may continue to cause a pincher effect on the nerves.
  2. Surgery may have helped that particular disk,  or bone spur,  but there may be other disk herniations or bone spurs that contributed,  or was the primary cause of the nerve irritation.
  3. The nerve itself has been compressed so long,  that there is a permanent change to that nerve.  This can explain the residual pain,  tingling and weakness associated with patients who had seemingly successful surgery,  with normal appearing post operative diagnostic studies.
  4. Discectomy and decompression surgery may have caused a development of an instability pattern to the spine.  The disk is a ligament which holds the spine bones in proper position to each other.  Sometimes,  disk herniations occur because the ligament function of the disk is no longer working.  While the disk is removed in hopes of reducing the pincher effect on the nerve,  if the real reason for the pain is abnormal bone movement (instability), removing the herniated disk,  and the necessary removal of some of the tissues and bone to achieve that removal can actually increase the  instability. If this is the real reason for the pain,  a stabilization procedure may be the only solution to the continued pain.
  5. Patients with medical problems such as diabetes,  or a neuropathy could have continued pain despite what appears to be a successful discectomy surgery.  Patients with certain medical conditions must understand that their underlying medical problem may compromise the results of surgery.
  6. If a person has good resolution of pain,  then has sudden recurrence of pain after a period of time,  there is a concern that another piece of disk material herniated again.  The other possibility is a break of the spine area called the pars interarticularis secondary  to the weakening of that area while the disk material is exposed.   Usually,  these causes are identified by post operative diagnostic studies such as MRI’s,  X-rays,  and CT scans.

If you do have continued back and leg pain after discectomy surgery,  please see your Surgeon.  If there is a mis match in expectations,  that a good discussion about the expected goals and residual discomfort should help you understand your disappointment.

If there is little improvement,  or worsening of complaints,  you may need additional diagnostic studies to make sure you do not have some of the above causes of pain.    If the studies are not revealing,  you may have residual pain that may improve with other modalities such as medications,  therapy or injections.

 

Citations

  • Ren H, Geng W, Ma J, Xu H, Li Z, Pang L, Li Kunpeng. [CORRELATION ANALYSIS OF CHANGES OF SPINE-PELVIC SAGITTAL PARAMETERS BEFORE AND AFTER OPERATION AND EFFECTIVENESS IN PATIENTS WITH LUMBAR SPONDYLOLISTHESIS]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Oct;29(10):1269-74. PubMed PMID: 26749737

No comments

Leave a Reply

Your email address will not be published. Required fields are marked *

*
*

Disclosure Statement

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
Please note all articles, blogs and Q&A’s on this site are general information and are not to be used as medical advice for individuals. No specific diagnosis or treatment should be made based on this information. Only a physician can provide you with advice specific to your situation. Please followup with your physician if you would like to discuss your individual condition.

If you are having a medical emergency,  contact your Doctor immediately,  or go to the Emergency Room.
ShimSpine and ShimSpine.com is committed to honoring and respecting the privacy and anonymity of the individuals using its website(s) and/or services. The purpose of this Privacy Policy is to inform the individuals about the collection, processing and protection of information done by ShimSpine what information we collect, why we collect this information and how we use this information.

This Privacy Policy will be reviewed regularly to reflect the up-to-date practices of ShimSpine.