Why does back pain persist after surgery?

Living with severe back pain can be debilitating. If left untreated, the pain can make it difficult or impossible to perform everyday tasks.

There are a number of treatments that can address the many causes of back pain, including surgery. While surgery can make a big difference with certain kinds of pain, people sometimes think it will make all their discomfort go away. Surgery is not always a cure-all. And it’s important to understand what you can (and shouldn’t) expect from spine surgery, so you go into the procedure prepared for what comes next.

One of the most important parts of my job is helping patients understand their back and spine conditions and what’s causing their symptoms. With that in mind, let’s look at the most common causes of back pain in adults, and how we treat these conditions.

What causes back pain in adults?

Some back pain in adults is normal. In fact, 80 percent of adults will experience lower back pain at some point in their lives. As we age, back pain often occurs due to degenerative conditions such as arthritis. Degenerative conditions cause parts of the back to gradually break down, becoming weak and painful.

Degenerative disc disease, for example, causes the discs (vertebrae) that hold the spine together and absorb shock to gradually degenerate. They become less effective at performing their function over time, which causes pain. When people have a sedentary lifestyle and lose strength and flexibility in their core muscles (abdominal, low back and oblique muscles), this places more stress on the degenerative spine and accentuates the back pain.

Spine conditions that cause degeneration often cause pain in the arms or legs. That’s because as the disc wears down and loses height, the neuroforamen (the space where the nerves exit the spine) narrows and pinches on the nerves. As a result, pain radiates down the length of the nerve and makes the arm or leg numb and weak.

One of the most common – and most painful – of these nerve symptoms is called sciatica, in which the sciatic nerve in the spine is pressed or pinched, causing pain to shoot down the lower back and legs. Sciatica is caused by degenerative back diseases, such as herniated or degenerative discs.

Can surgery help any kind of back pain?

We almost never recommend surgery as a first step for treating back conditions. Traditional spine surgery is invasive and, like any surgical procedure, it comes with the risk of complications. Patients need weeks or months to recover, depending on the procedure.

Most often, we prescribe non-narcotic pain medications, physical therapy and steroid injections to help strengthen problematic areas and alleviate the local inflammation of our patients’ bodies. If none of our non-surgical pain relief methods are effective, we’ll consider surgery.

Why can back pain persist after surgery?

While we can fix some painful, nerve-pinching conditions with surgery, the degenerative diseases that cause them don’t just go away.

Let’s say I’m treating a patient’s sciatica through spinal fusion surgery. This procedure involves removing arthritic bone that is pinching on the spinal nerves, as well as joining several vertebrae in the lower back, using bone from another area of the body to help the spine “bridge” the area that’s pressing on the spinal nerve to relieve that pressure. This surgery is effective at treating the leg or arm pain that radiates into the extremities, because the nerves are no longer pinched or compressed.

But surgery does not necessarily stop degeneration in other discs or joints, which is the condition that caused the patient’s back pain and sciatica in the first place. Essentially, spine surgery can treat the symptoms of degenerative diseases, but usually not the cause, which is usually genetic.

Spine surgery can treat the symptoms of degenerative diseases, but usually not the cause. via @MedStarWHC

Find out if spine surgery can treat your condition by scheduling an appointment today.

What to expect from surgery

Some people find their back or neck pain temporarily improves after surgery. But this is not something I can tell all patients to expect. For most people, even those who see improvements, surgery won’t be a permanent back pain solution.

I tell patients to focus on what I can fix. Surgery is incredibly effective at treating pinched nerves and associated pain, weakness or numbness that occurs in the arms or legs. Many patients wake up from their procedures and have instant pain relief in their arms or legs. Weakness tends to get better after a few weeks, but numbness can take longer to fade away, and sometimes doesn’t ever go away completely.

But I make sure my patients understand that they may need to rely on other treatment methods to address chronic back pain. I show my patients images of their spines, explain that pain may arise in the future and point to where it could happen.

As with anything in life, the fear of the unknown makes dealing with pain scary. But once you really understand your condition and know what to expect, the pain can become easier to handle.

Neck and Back Pain Basics: What You Need to Know

Tune in to the full podcast interview with Dr. Tannous.

Neck and back pain are leading causes of disability in the United States. Fortunately for those who suffer, there is an increasing number of treatments available, ranging from non-surgical therapies to state-of-the-art, minimally invasive procedures.

The first step, experts say, is pinpointing the exact cause of the problem.

“The source can range from herniated discs and compression fractures to strains, sprains or plain old arthritis,” says Oliver Tannous, MD, an orthopaedic spine surgeon specializing in state-of-the-art, minimally invasive and motion preservation techniques at MedStar Orthopaedic Institute at MedStar Washington Hospital Center.  “But regardless of the cause, one thing is pretty much the same: Patients are often in debilitating pain, and unable to do the things they want, like pick up their grandchildren or drive to the store. It affects their overall happiness and quality of life.”

Different diagnoses and symptoms require different treatment plans. Dr. Tannous believes the journey to a pain-free state should start with the most conservative interventions possible.

“Since a sprained muscle explains acute neck or back problems for the majority of patients, I’ll first recommend physical therapy, or prescribe anti-inflammatory medication,” he says. “It is remarkable how a short course of physical therapy can improve strength, flexibility, and posture and often this is all it takes to get better.”

For those who still experience pain, interventional pain management techniques such as steroid injections or facet joint ablations often do the trick. Surgery is only considered after less invasive treatments have been tried, and failed. Even then, there’s good news.

“Spine surgery today is vastly different than it was 10 to15 years ago,” Dr. Tannous explains. “We use advanced surgical techniques, requiring smaller incisions, and resulting in shorter hospital stays, faster recovery, less post-surgical pain and, ultimately, better outcomes.” 

Recent advances in surgical techniques include cervical (neck) disc replacement using a mobile implant rather than fusion to preserve range of motion in the neck. When a fusion is needed, it can now be done with incisions an inch and a half long. For older patients with compression fractures that don’t resolve on their own, another new treatment uses a needle rather than surgery to inject cement directly into the spine, often eliminating pain immediately. And, for disc herniation, the minimally invasive approach Dr. Tannous employs uses tubes, requiring only tiny incisions.

With so many new technologies available, people needn’t suffer from back pain, limit their quality of life, or worry about treatment.

“We’re in this together,” says Dr. Tannous. “My job is to find a way to solve your problem in the best way possible—with or without surgery.”

Tune in to the full podcast interview with Dr. Tannous.