Many surgeries are considered routine in nature, with a clear prognosis and predictable recovery period. For example, if an appendectomy is performed by the surgeon properly, the patient will heal and go on living life in the same manner as before their surgery.
A similar generalization cannot be made for spinal surgery. In fact, such a large percentage of back surgery patients, 10 - 40 percent, suffer from complications or lingering challenges that there is a named syndrome to classify these patients under, Failed Back Surgery Syndrome. These patients often suffer from uncontrollable pain and weakness that is highly debilitating.
Along with having lower success rate than most surgeries, back surgery by itself is considered high-risk with severe or life threatening events occurring in approximately 5% of surgeries.
Complications of back surgery include:
Spinal Fluid Leaks
Blood Clots Resulting in Heart Attack or Stroke
Significant Blood Loss
To compound the problem further, the long-term success rate of back surgery is extraordinarily poor. This is why most physicians will only consider surgical intervention as a last resort after all non-surgical and conservative options have been exhausted. This change in approach has become more main stream in recent years due to the higher success rate and lower risk of non-surgical interventions.
Why Are Results of Back Surgery So Varied and Detrimental?
It is often a challenge for doctors to identify the source of a patient's pain. Back pain can result from things that are visible on MRIs such as pinched nerves, herniated discs and spinal stenosis, as well as from things not visible on a MRI. During the diagnosis process, a doctor will try to associate MRI images to what they learn during the exam in trying to determine the source of back pain.
In addition to the challenges of identifying the correct source of back pain, the act of surgery itself can often create new areas of back pain. At an annual meeting of the American Academy of Pain Medicine, Dr. Lynn Johnson, MD, who was serving as a moderator during a moratorium on surgery, stated, "Just about any approach is better than having surgery because all the studies have shown that, if you take a surgical population and non-surgical population, they all seem do the same in five years." There have been several studies that support Dr. Johnson's assessment, there is not a large difference between patients who had surgery and patients who did not after a period of 5 to 10 years.
Common Causes of Failed Back Surgery Syndrome include:
The tissue that causes the back pain is not removed during surgery.
The surgery results in scar tissue forming which creates a larger nerve compression than originally existed.
The surgery changes the mechanics of the spine resulting in additional pain and degeneration.
The causes of the back pain are never remedied and the back pain returns.
Assessing Different Types of Spinal Surgeries
Some types of spinal surgeries are more risky than others. When considering a surgical intervention, it is important to understand which surgeries are high risk and which are lower risk.
Spinal surgeries with a high risk of complication include:
Surgeries where more than one segment of the spine is operated upon
Surgeries that require muscles and ligaments to be cut through
Spinal fusion to stop the motion at a painful vertebral segment
Laminectomies where a portion of the vertebral bone is removed
Surgeries requiring general anesthesia
Spinal surgeries with a lower risk of complication include:
Microdiskectomy that uses a minimally invasive surgical instrument or laser to remove the herniated disc
Surgeries that impact a singular segment of the spine
Surgeries that do not require cutting through muscles and ligaments
Surgeries that do not require general anesthesia
In addition to understanding the level of risk, it is also important to understand the typical outcome of the type of spinal surgery being considered. Below are spinal surgeries that have the best results:
Kyphoplasties to treat the pain caused by spinal fractures
Microdiscectomies at one location on the spine with pain in one leg
Surgeries that address an unstable spinal segment with hypermobility
Although surgery is higher risk than other forms of treatment, in some circumstances spinal surgery is the best means of pain relief and treatment once non-surgical remedies have been exhausted. These situations would include:
Pain resulting from severe spinal cord compression or damage.
Pain caused from spinal nerve or cord pressure after spur removal
In some instances, surgery would be the least desirable means of seeking pain relief. In these instances, surgery has shown to have the least effectiveness:
Fusions caused by arthritis
Pressure caused by spinal stenosis
Herniated discs causing low back pain
Only 5% of patients will end up requiring spinal surgery. Spinal surgery is not only high-risk, it is also costly, has long recovery periods and high rates of back pain recurrence. It is always recommended that all non-surgical methods of pain relief are exhausted before considering spinal surgery as a final option for a patient.