Dear Dr. Lowell,
I am an 85 year old woman that was very active. Pain developed in my lower back, traveled over to the hip and down the outer side of my left leg down to the knee. The doctor said that the discs were fused and affecting the nerves in my left leg. So, I went to the hospital for an operation. However, the pain was still there and I could not walk more than 50 feet. I was sent for therapy, then xrays and another MRI. The results of both showed nothing wrong. No one seems to have an answer. Have you any ideas?
Mrs. S., Ocala
Dear Mrs. S,
It is unfortunately not at all uncommon for me to see patients in my office who have had back surgery which either didn’t work at all, or which worked for a while and then pain returned later. It is a complicated topic, and there are several reasons why a back operation may not work. Sometimes we can find what is wrong, and sometimes the reason for the continued pain remains a mystery.
One possible cause of continued pain is some nerve pinching which was missed by the first operation. Another is scarring and clumping of the nerves within the spinal canal. Both of these problems can be picked up on a repeat MRI, and that is probably why one was done on you.
There are other causes of pain which do not show up on an MRI. An unstable spine can cause pain that could worsen after surgery unless the operation was specifically designed to deal with the instability. This would be better evaluated by special x-rays. Often, patients with curvatures in their backs (scoliosis) have continued pain in their backs unless the curvature is stabilized properly.
As I’ve said, sometimes we just can’t find a good explanation for the pain continuing. If we can find the probable reason for the continued pain, you would have a choice of either continuing your pain shots and therapy, or going for a repeat operation to correct whatever problem exists. This needs to be considered carefully, since the chance of repeat surgery helping is never quite as good as the chance you get the first time around. If we can’t find a good explanation for your pain, treatment would have to stay with the conservative measures such as injections and pain management techniques.