Failed Back surgery; part 3

So why does surgery for back fail so frequently? There are many reasons for this. Some of them include:

Bad surgeon and this is a common reason for many patients. Many surgeons are simply in a rush to make money and fail to work up the patient. Most of these surgeons are just technically poor surgeons.

Undertaking surgery as a first resort for back pain is a big NONO. Surgery should never be the first choice for back pain. There are rare circumstances when surgery is undertaken for back pain such as when bowel or bladder incontinence is present, but the majority of patients do not need surgery as the initial treatment.

Poor technical surgery which means the nerve compression is not effectively relieved. The surgeon also induces a lot of trauma from poor skills.

Inadequate surgery is often a common reason for continuing back pain.

Wrong surgery is often a cause of recurrent back pain. Sometimes the patient needs a different treatment and surgery is not the answer.

Doing unnecessary surgery can also worsen back pain.

Painful disc disease which could be due to ongoing disease in the discs above or below the vertebrae operated upon. The numbers of individuals who have this problem is close to 17%. These patients need to be initially treated with medical therapy before undertaking surgery

Pseudoarthrosis: Sometimes fusion of vertebrae may have been inadequate leaving the discs still mobile. A history of smoking before and after surgery is often associated with this problem. About 15% of cases have this problem.

In some cases, the recurrent pain is due to excessive healing or fibrosis. The diagnosis is made by MRI and occurs in about 10% of individuals.