Pain after back surgery

If the hoped-for improvement of the pain problem does not occur after an operation, there can be a variety of reasons for this. Despite careful medical examination and the most modern radiological methods (MRI), it is often difficult or even impossible to unequivocally identify the anatomical cause of a back pain problem. Due to the high level of suffering suffered by affected patients, surgery is sometimes carried out even under these conditions. 

Between 10 and 40% of spinal operations performed do not lead to the hoped-for success and result in PSPS. Despite this balance, the number of back operations performed annually is increasing rapidly. The reasons for this development are diverse and cannot be justified by medical developments alone.

It has been known for decades that with every additional back operation carried out, the hope of a life without back pain dwindles. After the first back operation, 60 to 90% of those operated on can look forward to an improvement in their back pain. If a second back operation is necessary, only 30% of patients benefit from pain reduction. After the fourth back operation, only 5% of the affected patients benefit.

The treatment of chronic pain after back surgery requires an interdisciplinary assessment by various specialists. In this way, individually tailored therapy with different elements can be aimed for.

Conservative therapy
The focus of all therapeutic efforts is training the back muscles. Well-trained back muscles can relieve the strain on the spine and thus reduce pain. Pain medication can be used to support this.

Radiofrequency treatment
Degenerative changes in the facet joints of the spine often play a decisive role in the pain development process. Particularly after spinal fusion operations, the neighboring facet joints can be overloaded (so-called connecting segments). Radiofrequency treatment is an important option, especially in these cases. The goal of radiofrequency treatment is the heat destruction of small nerves (medial branch nerves), which carry the pain signals from these facet joints to the brain. If the affected medial branch nerves are successfully destroyed, pain control improves. The improved pain control enables more efficient training of the back muscles.

Neuromodulation
If conservative therapy measures and radiofrequency treatment only provide inadequate pain control, neuromodulation treatment can be considered. In particular, patients with PSPS who suffer from radiating pain can benefit from neuromodulation treatment. Using a spinal cord stimulator, electrical impulses are delivered directly to the spinal cord and in this way mask the pain impulses.

• Nachemson AL. Evaluation of results in lumbar spine surgery. Acta Orthop Scand Suppl. 1993;251:130–133.
• Thomson S. Failed back surgery syndrome: definition, epidemiology and demographics. Br J Pain. 2013;7:56–59.
• Boden SD, et al., Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72(3):403-408.