Back surgery is often presented as the definitive solution for severe, chronic back pain. However, for a significant number of patients, pain unfortunately continues. Some might have worsening of the pre-existing pain, some might develop new, different types of pain. If you are one of these individuals, know that you are not alone, and understanding the potential reasons is the first step toward finding relief.
This article explores common causes for persistent or recurrent back pain following spinal surgery.
The Reality of Chronic Pain After Spinal Surgery
While surgery successfully addresses structural issues like a herniated disc or severe spinal stenosis in many cases, the spine is a complex system. It’s crucial to understand that surgery treats a structure, but pain is influenced by many factors.
Chronic Pain After Spinal Surgery (CPSS) is a diagnosis defined by the International Association for the Study of Pain (IASP) as a chronic or novel type of pain that occurs after spinal surgery. It is characterized by persistent back or leg pain lasting more than 3 months after the procedure. The pooled prevalence of this persistent pain is estimated to be about 15% to 40% of all patients who undergo lumbar surgery. This condition was previously called Failed Back Surgery Syndrome (FBSS).
Here are the primary reasons why pain might not fully resolve:
- Non-Diagnostic Pain Sources Sometimes, the pain you feel isn’t coming from the exact spot that was operated on.
- Facet Joint Syndrome: The small joints at the back of the spine (facet joints) can be a primary pain generator. If these weren’t addressed, or if arthritis has advanced elsewhere, they can cause persistent pain.
- Sacroiliac (SI) Joint Dysfunction: Pain originating from the joint connecting the spine to the pelvis can mimic true spinal pain and often goes undiagnosed before surgery.
- Adjacent Segment Disease (ASD)
The spine works as a kinetic chain. When one segment is fused or stabilized during surgery (such as in a spinal fusion)
, the stress and load are often transferred to the levels immediately above or below the operated area.
- This increased mechanical demand can cause accelerated degeneration (arthritis, disc collapse) in those neighboring segments, leading to new pain over time.
- Scar Tissue and Failed Fusion
- Scar Tissue Formation (Epidural Fibrosis): During healing, scar tissue can form around the nerves or spinal cord. This tissue, while normal, can sometimes tether or irritate the nerves, leading to recurrent symptoms.
- Pseudoarthrosis (Failed Fusion): In fusion surgeries, if the bone doesn’t fully heal across the space, the segment remains mobile. This instability causes mechanical irritation and inflammation, resulting in persistent pain.
- The Lingering Effects of Chronic Pain
If you had severe pain for many months or years before surgery, your nervous system can become “sensitized.”
- Nerve Sensitization (Central Sensitization): Your nerves essentially become “wound up” and overly sensitive to normal signals. Even after the structural problem is fixed, the nervous system can continue to transmit pain signals. This requires focused pain management techniques, not just structural correction.
- Psychological and Lifestyle Factors
Pain doesn’t just live in the back; it lives in the brain. Factors like mood, stress, sleep quality,
and physical deconditioning significantly influence pain perception.
- Deconditioning: Long periods of inactivity before surgery often lead to muscle weakness (especially core muscles). If this is not aggressively corrected after surgery, instability and fatigue can cause persistent aching.
- Mental Health: Depression and anxiety are closely linked to increased pain intensity and decreased tolerance.
What Can You Do Now? Moving Beyond Surgery
If you are struggling with post-surgical back pain, the key is shifting from a purely structural approach to a comprehensive, multi-modal strategy.
The key to relief back pain after surgery:
- Thorough History Taking and Physical Examination: Pinpointing the true source of ongoing pain, which may not be the surgical site itself.
- Targeted Interventional Procedures: Utilizing modern techniques like epidural steroid injections, radiofrequency ablation, or epidural balloon neuroplasty to quiet sensitized nerves and lyse scar tissue.
- Integrated Rehabilitation: Coordinating with physical therapists focused on spine-specific strengthening and neuromuscular retraining to restore stability and function.
Don’t settle for pain after back surgery; take control of your recovery. The next step is seeking an evaluation focused on multimodal, targeted interventional pain management to address these complex, non-structural contributors to chronic pain.
Rarinthorn Choomsai Na Ayuthaya MD. Interventional pain specialist
