Many people that suffer from lower back pain feel like surgery is their best option. They may have tried some form of conservative care, like physical therapy or chiropractic care, with little to no change in their symptoms, and decided that spinal surgery was their “last resort.” Or they may have just skipped conservative measures and went straight to surgery thinking that it was the only way to really fix their back. Unfortunately, the success of spinal surgery is not as high as you might think.
Simply, Failed Back Surgery Syndrome (FBSS), is when someone experiences no change in lower back pain following back surgery. In some cases, patients even report a worsening of symptoms following surgery. The incidence of FBSS varies from study to study, but most studies agree that 20%-40% of back surgeries result in FBSS. In many cases, the person feels better for a period of time after surgery, only for their symptoms to return later.
FBSS can be broken into two separate groups. The first group consists of those where surgery was not clearly indicated. Meaning a surgery was not needed in the first place. The second group, which is much larger than the first, is made up of those that clearly needed surgery, however the surgery did not give the expected result. This often happens in disc surgeries when the bulging disc is removed, however another condition was overlooked, such as spinal stenosis.
Certain people are at a higher risk for FBSS. Risk factors include smoking, obesity and age, the older the person is at the time of surgery, the higher the risk of FBSS.
Probably the most common cause of FBSS is a recurrent disc herniation. During a discectomy procedure, not all of the disc is removed. The remainder of the disc can herniate at a later time, thus leading to pain. In recurrent disc herniations, the patient usually feels better immediately following the surgery, however pain returns later. There is also some evidence to show that removal of a disc at one level can lead to herniations at other levels.
Studies have shown that as many as 10% of back surgeries result in infection. This infection can lead to increased back pain. There are a number of factors that can make a post-surgical infection more likely, the most common is smoking. One study estimated that as many as 90% of post-surgical infections occur in smokers. Other risk factors for infection include diabetes, obesity and the length or complexity of the surgery. The use of metal implants in spinal fusion surgery also increases the risk of infection.
Spinal stenosis occurs when there is narrowing of the spinal canal, leading to pressure on the spinal cord or spinal nerves. Symptoms typically include pain, numbness, tingling or weakness in the legs. Stenosis can occur years after laminectomy surgeries, or even surgeries performed to correct stenosis itself. Spinal stenosis is often overlooked as a possible cause of symptoms when a disc bulge or herniation is present. In these cases, the disc may be repaired surgically, and stenosis left unaddressed, significantly affecting outcomes.
Many studies have shown that patients with FBSS notice significant improvement in their symptoms through chiropractic care. If a spinal misalignment is leading to increased pressure on the disc, adjustments can help alleviate the pressure and help relieve pain. Lack of spinal motion is common after spinal surgery, especially spinal fusions. Chiropractors are able to help restore motion to the joints of the spine, further helping with symptoms of FBSS. Even if you have had spinal surgery, chiropractors can alter the technique to safely and effectively treat you. For more information on chiropractic care, click here.
Since recurrent disc herniations are a common post-surgical complication, those with FBSS may gain relief from spinal decompression therapy. Spinal decompression has been proven to be safe and effective in the treatment of disc bulges and herniations. At CORE Chiropractic in the Energy Corridor, we use the Back on Trac spinal decompression machine. This machine has a number of different protocols that allow us to treat you, even if you have already had surgery. You can find more information on spinal decompression here.
Another common cause of FBSS is the failure to complete post surgical rehabilitation. This rehabilitation is essential to heal, and maintain the spine after surgery. Even if you receive relief through chiropractic care, it is still necessary to perform proper stretching and strengthening exercises to maintain your progress. A chiropractor can tailor this rehabilitation program to fit the needs of those with FBSS.