Most people know that back surgery has a poor reputation for the number of times it fails. Almost everybody knows a relative or friend who had back surgery and who didn’t seem to get better or even got worse.
In my office, I will sometimes see patients who would benefit immensely from surgery, but they are too scared to have it because they think that back surgery would “Put me in a wheelchair.”
What causes back surgery to fail, and what can be done about it if it does fail? This is the answer that I give my patients: a successful result in back surgery requires three things. First, the patient needs to have a condition which can be treated successfully with surgery. Second, a good doctor needs to make an accurate diagnosis of this condition. Third, the surgery needs to be performed skillfully and well. I have seen surgery fail when any one of these principles are violated.
There is also the unfortunate fact that even in the best of hands back surgery does not have a one hundred percent success rate. Even the most skillful surgeon will have some failures even if everything is done correctly. Nobody really knows the reason for this. We have theories about scar tissue forming or about nerves not healing properly, but if the truth be told, nobody really knows for sure. The most successful procedures have success rates approaching 95%, but some other back operations can only claim an average 80% success rate.
What can be done for patients who have had failed back surgery? That really depends a great deal on the cause of the failure. When I see a patient in my office whose surgery didn’t work, the first thing we will do is obtain a number of tests to see if there is any problem remaining in the spine that can be corrected with further surgery. If there is, then we will address whatever is causing the problem. If there is not, then the best we can offer is a variety of pain management techniques such as injections, physical therapy, medication, or similar therapies. These treatments are often managed by a pain management physician. If I think that surgery may be helpful, I will discuss with the patient what I think are the odds of the repeat surgery working. Depending on the problem, these odds can vary from 50% to 80% or more. (I personally will not operate if the odds look lower than 50%.)