Failed Back Surgery Syndrome - Non-surgical care in Oregon
Back pain is the second most common reason people go to the doctor. Typically, patients with back pain will go to their portland doctor and try medication's to dull the pain and reduce inflammation. When that fails, x-rays are ordered which are usually inconclusive. Patient so I could put on a second dose of medication or refers to physical therapy. When that doesn't work, MRI's are performed which are also often not as helpful as we would like. Sometimes pockets of inflammation are revealed and injections are attempted. Sometimes… Usually… Some degree of degeneration to the lower back is revealed. Far too often, this degeneration is accused of being the culprit for the low back pain. Around 1/5 to 1/3 of all asymptomatic middle-aged people, if we ran them through an MRI machine, would have some degree of spinal disc pathology.
Failed Back Surgery Syndrome in Portland OR
As I said, so many people have low back pain and so many people have disc issues that are not problematic that the presence of disc herniation in a symptomatic patient is usually both common and an understandable result of many lower back surgeries. The previously mentioned degeneration, like progressing disk pathology is often the result of poor bio mechanics in the area. Orthopedic literature has suggested that a bone being out of place and/or not moving correctly requires only 7 to 10 days before it begins to produce degenerative changes to the articulation. Literature also suggests that it takes roughly 7 to 12 years of this degenerative process to begin to show overt signs on x-rays. You can imagine a fairly active athlete, who challenges their bodies in all sorts of ways, quitting their sport after high school or college and acquiring a desk job where they now sit on this frame for eight hours a day, before going home and sitting on it again for another 4 to 6 hours. We see this kind of patient in the office quite frequently, before they have even hit 30. Fast forward two someone who has had this pattern for 20 years or 30 years, and you have a lumbar spine with a lot of degeneration, work and life activities that are significantly disturbed, and a patient that feels like they've tried everything, with the doctor who is ready to try surgery.
Depending on what is revealed on the MRI, a number of different procedures may be attempted. There are some promising new procedures like disc replacement surgery, where they insert an artificial disc to maintain as much normal biomechanics and nerve root space as possible. But the most common procedure we see in our office is a lumbar fusion. Typically, the evidence of degeneration and bone spurring spans more than one vertebral level. The surgeon will often go in, shave down some of the bony overgrowth, remove the remaining disc material, and then surgically fuse two or more segments together. This is usually done with metal plates and screws to hold the segments in one specific configuration and with enough space around the nerve roots that they can function normally.
Ask any surgeon or engineer what the "stress-riser effect" is and they will explain why more and more surgeons are putting off surgery as long as possible. A back surgery is considered a success if the patient has the same or better condition as they had right before the surgery, five years hence. So if you go five years and one day and all of a sudden you feel worse than before you went in, it's still chalked up as a success. This fact makes it all the more shocking to hear that only half of our back surgeries are considered successes. My own father was one of the lucky ones after he herniated a lumbar disc lifting a fireplace. Our office is filled with patients who weren't so lucky.
The neurosurgeons we commonly refer to have followed the science and are not cut-first specialists. If you feel like you are anywhere on the road to surgery, or are looking for ways to avoid failed back surgery syndrome, or even curious as to what can be done to reduce the symptoms of a failed back surgery, please contact the clinic and we will see what the logical next steps should be and find out whether or not care will be safe and effective for you. If our clinic is too far from you, let us know where you live and we will try to find someone close to you that we know and trust.
