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 surgery with shorter recovery, better range of motion

Listen to Dr. Oliver Tannous' full podcast on the latest advances in spine surgery including cervical disc replacement.

For many years, the gold standard for surgical treatment of certain painful neck conditions has been a procedure called anterior cervical discectomy and fusion. This surgery can effectively relieve pain, but it limits the patient’s range of motion and places more stress on the discs above and below the fusion.

Fortunately, today spine surgeons have the technology to perform cervical disc arthroplasty (replacement)–placing an artificial disc between two vertebrae in the neck.

"Cervical disc replacement can be an excellent option for active patients as it maintains motion and potentially decreases the long-term issues that come with fusion surgery,” says Dr. Seyed Babak Kalantar, MD, chief of the Division of Spine Surgery in the MedStar Orthopaedic Institute at MedStar Georgetown University Hospital and the Co-Director of MedStar Spine Center.

Not all spine surgeons have adopted this technology. Those who have find it to be a phenomenal treatment option for some patients with painful neck conditions such as cervical disc herniation. Here’s how it works.

"We can treat some neck-related arm pain with disc replacement. It can avoid a spine fusion." via @MedStarWHC

How does cervical disc arthroplasty work?

The cervical spine is the portion of the spine in the neck. There are six discs in the cervical spine that rest between the vertebrae, the bones that make up the spinal column. The discs are spongy and act as shock absorbers.  

When there’s a problem with a disc, the spinal cord or nerves can be compressed or pinched. This can cause neck pain, along with arm pain, numbness or weakness.  

Traditionally, when physical therapy and medication didn’t relieve the pain, the main surgical option was anterior cervical discectomy and fusion. That surgery involves taking the disc out and replacing it with a piece of bone, a metal plate and screws that over time would fuse the vertebrae and stabilize that part of the cervical spine. The surgery relieves pain, but patients lose some range of motion because there is no longer movement between the fused vertebrae.  

“In cervical disc arthroplasty, instead of fusing vertebrae together, we replace the disc with an implant that mimics your normal disc motion,” says Dr. Oliver Tannous, Spine Surgeon at MedStar Orthopaedic Institute at MedStar Washington Hospital Center. “It basically functions as a joint that allows normal range of motion and reduces stress on the discs above and below.”  

The FDA approved the first cervical disc implant in the U.S. in 2007, which allowed surgeons to replace one problematic disc. In 2013, the first device was approved to replace two adjacent problematic discs.  

Who might benefit from this technique?

Cervical disc replacement can help people with conditions such as these if non-surgical treatments did not work:

  • Cervical disc herniation
  • Cervical radiculopathy
  • Cervical spinal stenosis
  • Degenerative disc disease  

This procedure is typically performed on patients younger than 60. The main reason for this is because most people 60 and older have a fair amount of arthritis in the neck. Cervical arthroplasty doesn’t cure the arthritis, so the neck pain can remain. In these cases, traditional surgery is recommended.

Recovery takes days, not weeks

The most amazing part about this technique other than sparing range of motion is the short recovery period.

When a traditional fusion is performed, the patient may be in a brace up to 12 weeks. This immobilizes the neck to allow the fusion to take place.

But when a disc replacement is performed, motion should not be locked up for very long. Patients are typically put in a brace for a couple days to help with the swelling, but then should be out of the brace and going about their normal activities.

There are patients who had surgery on Friday and were back to work on Monday. Activity is not restricted too much – it’s usually up to the patient to do what he/she can tolerate. Don’t engage in extreme ranges of motion or participate in contact sports right away, but go about daily activities.

Those experiencing neck and arm pain due to disc herniation or cervical spinal stenosis may not need surgery at all. About 75 percent of patients get better using physical therapy, anti-inflammatory medications or steroid injections. It’s only after those options have been exhausted that surgery is discussed.

For those in that small group that needs surgery, cervical arthroplasty can be a viable alternative. This procedure provides pain relief without the frustration of losing range of motion in the neck.

Schedule an appointment online or call 855-788-6464 to talk to a doctor about whether cervical arthroplasty might be right for you. 


Interested in hearing more? Listen to the full podcast with Dr. Tannous!

Keep moving to avoid and relieve back pain

Physical activity is vital for overall health, including for a healthy spine. Most people can avoid chronic back or neck pain by maintaining an active lifestyle and making a few simple posture changes.  

But what if you’re already experiencing neck or back pain? Is it too late to make a change? For most people, it’s never too late to improve spine health.  

Need a spine health check up? Schedule an visit with an orthopaedic specialist today!

I often see patients who come in with sudden, severe neck and back pain. It often flares up unexpectedly, such as when performing household chores. These patients often worry that they’ve damaged their spines. But in the vast majority of cases, physical therapy and sometimes non-narcotic medication will provide neck and back pain relief.

Let’s take a look at how a healthy spine works and why physical therapy is so effective to help you recuperate from and prevent future back pain.

Supporting your spine

Maintaining a healthy spine depends upon strengthening the muscles that bear its weight. The muscles around your back (often called “core” muscles) take some of the load off the spine’s lumbar vertebrae. These five large bones provide a supporting frame for the spine, but they aren’t made to hold its weight.

People experience back pain when their core muscles are too weak to support the lumbar vertebrae. If these vertebrae and the joints surrounding them bear too much weight over time, it can accelerate arthritis of the lower back, resulting in the sudden, intense pain I described earlier.    

It’s important to exercise the core muscles around your abdomen and lower back to stay strong. Many back problems are caused by inactivity and smoking.  

Inactivity and spine health

Americans spend an average of nearly eight hours per day sitting. Given that most adults have desk jobs, that number isn’t too surprising. But prolonged periods of sedentary behavior can have surprisingly severe effects on your health, so much so that this group of conditions has been given a name: “sitting disease.” Sitting disease increases your risk of obesity, high blood pressure, heart attack, cancer and more. And it also affects your spine.  

Did you know... “Americans spend an average of nearly eight hours per day sitting.”

When you’re sitting, your core muscles aren’t being worked. They sit dormant, becoming weaker the less they’re used. Making this problem worse is the fact that many people have poor sitting posture. Slouching can make it more difficult for the core muscles to bear weight and causes issues with spinal problems over time.  

Sedentary lifestyles are a common theme among my neck and back pain patients. When you’re younger, you can live an inactive life for years without back pain. But those years are silently taking a toll on your spine.  

If you must sit for most of the day, you can take proactive steps to guard against future back troubles. And if you already have back pain, these techniques are especially important to prevent it from getting worse.  

Developing healthy spine habits  

You can keep your spine healthy and avoid serious back pain by making a habit of exercising and stretching. I tell my patients they need to make core muscle exercises a part of their daily routine, just like brushing your teeth. Strengthening the core muscles helps keep your spine healthy. It’s that simple. Some exercises that I recommend include modified planks, the “superman” stretch or yoga. You may need to exercise a specific subset of core muscles depending on your condition, so ask your physical therapist or doctor which exercises you can perform to improve your spine health.  

If you sit at work, consider getting a standing desk. My patients rave about how much better their backs feel after they start using one. According to a growing body of research, reducing your sedentary time with a standing desk can also reduce your risk of cardiovascular disease and obesity, help you focus and avoid feeling tired while improving your mood at work.  

When you do sit, make sure to use proper posture. Keep your back straight and shoulders back. This posture helps maintain the natural curvature of the spine. You also should change your sitting position regularly, and get up to move around at least once per hour.    

sitting posture correction
A healthy sitting posture. Your head to kneecaps should make less of a letter C and more of a letter L.

You should be on your way to a healthier spine if you stick to these habits. But if you’re still experiencing pain, or your pain begins to radiate into your arms or legs, you could have a back condition that requires more intensive treatment.  

If you have back pain, or sit for long periods of time, don’t wait for the problem to get worse. Be proactive about your spine health – you’ll feel the benefits of being flexible and active, and enjoy years free of back pain.  

Request an appointment to discuss physical therapy options or call 202-877-6000 to learn more.