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Back surgery is indicated in a small percentage of patients with pathology at that level. It is likely that the decision you made to have back surgery to relieve your pain has been very difficult. So it can be very annoying that, after surgery, you continue to feel pain.


Failed Back Surgery Syndrome

Despite a careful diagnosis and a successful operation, some patients still experience pain after their surgery. This persistent pain or the continuation of previous symptoms is known as a failed back surgery syndrome and may affect your ability to perform your daily activities. The failure is not the surgery itself, since the main objectives of the surgery (which could include decompression and stabilization) may have been achieved. What failed was to reach the full resolution of symptoms.
Various factors affect the outcome of back surgery. Another possible cause is that the injury for which the surgery was performed is not the only reason for the onset of pain. Many times the main problem remains unresolved properly. In some, the pain may come from the damage caused by the surgical procedure itself.
It is very common to feel discouraged if back surgery does not help relieve pain or cause the appearance of others. The good news is that there are some options for treatment, such as therapies for chronic pain.


Epidural fibrosis

Scar tissue formation is common during the recovery period after back surgery. Pain in the scar tissue is uncommon since it does not have nerve endings that cause pain.
However, epidural fibrosis, which is the formation of scar tissue in the nerve root, can cause some pressure on the nerve roots and cause pain. Usually, the symptoms associated with epidural fibrosis appear in 6 to 12 weeks after back surgery. Many times patients have almost no pain after their surgery, but as the scar tissue closes, the pain may appear again and spread to the legs. Occasionally, nerve end damage caused by the patient’s original pain causes the patient to heal more slowly. If the pain is burning or persistent and its intensity does not change with the change in posture, it is possible that a scar is forming around the nerves.
Stretching exercises after the operation can help decrease the effects of postoperative scarring around the nerve root.


Problems after treatment

In decompression surgery, such as a laminectomy or discectomy, the nerve root can take a long time to heal, which would complicate the evaluation of the outcome of the surgery.

About three months after surgery, one or two of the following results may appear:
-In general, patients who are improving within the first three months after surgery continue that way.
-Patients who have not presented an improvement approximately three months after decompression probably do not perceive a substantial benefit from surgery.

Decompression of the spine will usually relieve pain in the patient’s leg immediately after back surgery. However, for 10% to 20% of patients, the pain will continue until the nerve begins to heal.
Usually, symptoms that include numbness/tingling or weakness take a little longer to resolve, and it can usually take up to a year for these symptoms to disappear. If the symptoms persist after one year, there may be permanent nerve damage, so the pain is unlikely to improve.


Fusion Failure

Fusion is like a broken bone that is trying to heal. Bone cells migrate from the injured bone to the bone graft from other areas, which can form solid bone tissue. It takes about a year for a solid bone to form. Certain activities such as those that include excessive movements, bad placement of screws, or the use of anti-inflammatories could inhibit the process of bone fusion. There may be failures in the implantation of bones in case the fusion does not occur, and this often leads to fractures, dislocations and chronic pain.
The patient may experience recurrent pain many years after spinal fusion surgery. This can happen because the level above or below the segments that have been successfully merged can fracture, which can cause pain. This is known as adjacent segment disease.
If you have chronic pain after spinal fusion surgery, look for the right options to relieve it.


You might also want to read: Surgical treatment for back pain

Minimally Invasive Spine Surgery

Fatty degeneration of multifidus muscle in patients with chronic low back pain and in asymptomatic volunteers: quantification with chemical shift magnetic resonance imaging.

Coblation nucleoplasty for adjacent segment degeneration after posterolateral fusion surgery: a case report.



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