Most patients experience improvement in their symptoms after surgery so don’t be too hasty in deciding that your operation has failed; sometimes recovery takes a bit longer than you expect. If it turns out that the surgery hasn’t corrected the original problem, or if surgical complications have led to a new problem, there are still treatment options:
- If the operation was partly successful, other therapies which weren’t effective for you in the past might work for you now (see Non-Surgical Treatments and Interventions).
- While having a second surgery isn’t something most people would want to consider, it may be the correct choice. Discuss the possibilities with your doctor.
Fortunately, there are very few situations that cannot be improved, so don’t give up.
A relatively small number of back surgery patients—fewer than 5%—come out of their operations with back or leg pain that is just as bad or worse than their original symptoms. Unfortunately in some cases, these symptoms are permanent. There are many reasons for what is called the “failed back surgery syndrome.” These include: surgery performed for the wrong reasons, surgery done at the wrong time, surgery done in the wrong part of the spine, the surgery’s failure to fully deal with the problem and damage caused by the surgery.
One of the most difficult components of failed back surgery is what doctor’s refer to as “sensitization of the central nervous system.” In these cases, the pain itself—rather than the physical abnormalities in the spine—becomes a problem. A pain “loop” develops, causing new symptoms or a worsening of old ones. The patient feels more pain but it is pain which has nothing to do with structures in the spine. This problem can develop in people with long standing back pain who never undergo surgery (see Pierre’s Story: Pain Disorder) but it is a virtual certainly following the huge negative emotional impact of a failed back operation.
Even with early recognition and management, this type of pain is a challenge. Patients should be referred to a multidisciplinary program for behavioural cognitive therapy where they will be assessed and treated both physically and psychologically for their ongoing pain, anxiety and depression.
A few patients may be candidates for specialized surgery to alter the pain pathways themselves. The surgery, spinal cord stimulation, uses implanted electrical devices to modify how the body processes the signals and turns unbearable postoperative pain into tolerable abnormal sensations.