Spinal fusion is one of the most widely performed surgeries for spine conditions. In fact, between 2004 and 2015, the volume of elective lumbar spinal fusion rose 62.3%. While spinal fusion helps resolve spinal instability, it doesn’t work for everyone. The rate of failed spinal fusion surgeries is significant, leaving many patients with persistent back pain after the fusion procedure.
Despite the risk of failed spinal fusion, hope is not lost for patients struggling with symptoms of spinal conditions. Especially with the latest advancements in spinal medicine, solutions are available for patients with debilitating symptoms following fusion.
What is Failed Back Surgery Syndrome?
Patients who underwent a failed spinal fusion surgery may be diagnosed with failed back surgery syndrome. Also known as FBSS, this condition is defined as either:
- Lumbar spine pain that persists despite surgical treatment and has an unknown cause
- Lumbar spine pain that develops after surgical treatment for spinal pain in the same area
FBSS is a blanket term used for patients who haven’t experienced a successful result from back surgery.
How Common is Failed Spinal Fusion?
As many as 40% of patients who undergo surgery for chronic lower back pain continue to experience pain after the procedure. This percentage can differ based on the type of procedure, as well as the patient’s preoperative condition.
Failed back surgery syndrome is the most common in conventional open back surgery and spinal fusions. Minimally-invasive surgical methods reduce the risk for FBSS.
Reasons For Failed Spinal Fusion
Spinal fusion surgery may fail for a variety of reasons, including:
Failure To Fuse (Pseudoarthrosis)
Spinal fusion is accomplished with bone graft material, which stimulates the fusing of the targeted vertebrae. In some cases, the bone graft fails to fuse the vertebrae. This is known as pseudoarthrosis or non-union. With pseudoarthrosis, there isn’t sufficient bone formation in the recovery time after spinal stenosis. This often occurs as a result of poor bone healing.
Hardware Failure
Hardware including plates, rods, and screws is often used in spinal fusion surgery. These devices stabilize the spine to facilitate the healing process and prevent failure. Unfortunately, the hardware used in spinal fusion isn’t infallible. Given that it’s constructed of metal, it can wear out and become damaged over time.
In patients with severe instability, the hardware must undergo additional stress and, therefore, is more likely to fail. Additionally, spinal fusion implants are more prone to failure in patients who are overweight, as well as those with multiple fused segments.
Scar Tissue Development
Scar tissue is a prevalent cause of failed back surgery syndrome. Your body naturally forms scar tissue to replace tissue that’s damaged due to injury, disease, or surgery. Unfortunately, this type of tissue doesn’t always benefit your healing process. After spinal fusion, scar tissue replaces the muscle, bone, tendon, or ligament tissue that was removed during the procedure. Alone, the scar tissue is unlikely to cause problems, as it doesn’t contain any nerve endings. However, if it interferes with nearby nerves in the spine, it can cause discomfort.
In some cases, scar tissue may adhere to the nearby bone after spinal fusion. If a nerve is close to this area, it may get entangled in the scar tissue. A spinal nerve caught in the scar tissue may get pulled and irritated with specific motions. This can result in persistent back pain after spinal fusion surgery.
Risk Factors For Failed Spinal Fusion
While the exact reason for a failed spinal fusion often isn’t clear, certain factors may increase your risk of FBSS. These factors include:
- Smoking cigarettes or using any type of nicotine product
- A sedentary lifestyle
- Poor posture
- Infection after the spinal fusion procedure
- Spinal instability or abnormal movement of the spine
- Disc disease at areas of the spine other than the segment that was operated on
- Arachnoiditis, which results from inflammation of one of the membranes that enclose the spinal cord nerves
Possible Solutions For Failed Spinal Fusion
As aforementioned, implementing a minimally-invasive alternative to spinal fusion can reduce patients’ risk of developing FBSS. Innovative non-fusion implants are currently being used to stabilize the spine and resolve chronic back pain without having to fuse the patient’s vertebrae.
Of course, it’s preferred to prevent failed spinal fusion before it develops. But, for patients who are currently suffering from FBSS, treatment options are available.
Treatments for persistent back pain caused by a failed spinal fusion include:
Physical Therapy
Physical therapy is widely used to help patients diagnosed with FBSS. With non-invasive methods, physical therapists can help resolve pain, inflammation, and lost mobility.
Generally, physical therapy programs include targeted exercises to boost strength and flexibility. For FBSS, physical therapists may focus on exercises that strengthen the core and back muscles, which support the spine.
Additionally, physical therapists can correct abnormalities in patients’ gait and posture to reduce the strain on the spine with day-to-day activities.
Lifestyle Modifications
With symptoms of a failed spinal fusion, patients should consider making specific changes to their lifestyles, including:
- Refraining from high-impact activities
- Staying mobile with low-impact exercises, such as walking
- Maintaining a healthy weight
- Quitting smoking
- Eating a balanced diet that’s rich in nutrients
Anti-Inflammatory Medication
Anti-inflammatory medications can help patients manage pain and inflammation caused by a failed spinal fusion. Your physician may recommend over-the-counter medications or prescribe prescription drugs, depending on the extent of your symptoms.
Surgery
Patients may need to undergo another spinal surgery to fully resolve the symptoms of a failed spinal fusion. Understandably, many patients in this scenario are hesitant to undergo another surgery, given that the last procedure failed. These patients can consider minimally-invasive spine procedures.
Modern and progressive surgical techniques are a safer solution with a lower risk of complications when compared to conventional spine surgery. Additionally, innovative non-fusion spondylolisthesis and stenosis treatment surgery implants can help patients overcome chronic back pain without having to undergo such a serious procedure as spinal fusion.
If you’re experiencing lasting pain after recovering from spinal fusion surgery, contact a spine specialist immediately to learn about your treatment options.