Surgical treatment of a herniated disc provides a radical solution: the hernia is removed surgically, and relief often occurs almost immediately. However, this method has quite a few drawbacks, the main ones being:

  • High risk of recurrence, with only temporary relief after surgery;
  • During the operation, the spine is traumatized, which can lead to various complications, including disability.

WHY DOES PAIN OCCUR AFTER SURGERY?

In neurology, pain after spine surgery is commonly referred to as the “operated spine syndrome.” This term originates from Western literature where it is widely known as Failed Back Surgery Syndrome (FBSS) — literally, “syndrome of unsuccessful lumbar spine surgery.” Similarly, for the cervical spine, the term Failed Neck Surgery Syndrome (FNSS) is used. Another synonym is post-laminectomy syndrome.

Operated spine syndrome describes the condition of a patient who, after one or multiple surgeries aimed at reducing lumbar or nerve root pain (or both), continues to experience persistent back pain following the surgery.

STATISTICS:

According to statistics, the recurrence rate of back pain after lumbar spine surgery ranges from 15% to 50%, depending on the type of surgery and evaluation methods. Even if we assume the lower figure of 15%, in the United States alone—where about 200,000 such surgeries are performed annually—there should be approximately 37,500 new patients each year experiencing post-surgical back pain. Globally, the percentage of such patients is lower than in the US (Western European countries combined perform a similar number of surgeries annually), but this medical issue remains very significant worldwide.

CAUSES OF BACK PAIN AFTER SURGERY:

The progression of operated spine syndrome is due to the fact that each repeated surgery, such as decompression or so-called meningo-radiculolysis, often increases pain because it worsens scar and adhesive tissue formation at the surgical site.

Common causes of recurring back pain or worsening after surgery include:

  • Herniation at a new spinal level;
  • Residual fragments of a sequestered disc;
  • Unresolved nerve compression around the nerve root funnel;
  • Undiagnosed spinal segment instability, which causes dynamic or constant compression of ligaments and spinal nerve roots.

However, surgeries that fully remove the sequestered disc fragment under intradiscal endoscopy control, decompressive operations with foraminotomy, and stabilization surgeries also do not always eliminate pain after spine surgery.

Unfortunately, in more than 20% of cases, the cause of lumbar pain and leg radicular pain remains unknown, despite advanced diagnostic methods.

CONCLUSION:

The clear conclusion is that further surgeries to relieve pain after spine surgery should be avoided, as they often worsen the situation instead of helping. Therefore, surgical intervention should be used only as a last resort, after thoroughly trying non-surgical methods first.

WHY IS SURGERY NECESSARY?

A large, herniated disc can directly affect the spinal canal by compressing nerve roots and blood vessels. This results in an intense pain syndrome that cannot be relieved by painkillers, impaired motor function of the limbs (paresis, paralysis), and dysfunction of pelvic organs (urinary and fecal incontinence, constipation, frequent urination, erectile dysfunction). When conservative treatments fail, surgery is used to eliminate these problems.

The surgeon’s goal is to relieve any pressure on the nerves and nerve roots by removing the protruding disc material. The operation is called spinal canal decompression and involves a procedure known as laminectomy. Before the surgery, a clinical examination and imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) are conducted to determine the exact location of the damaged disc.

WHAT HAPPENS DURING THE SURGERY?

Preliminary steps: As with all surgeries performed under general anesthesia, about an hour before the operation, you will receive a preoperative injection to dry internal fluids and induce drowsiness.

Surgical procedure step-by-step:

After anesthesia, the patient is placed face down on the operating table. A roll or a bend in the table is positioned so that the lumbar spine arches upward. The surgeon makes the first incision along the midline of the back at the required level. The incision is deepened until the sharp, backward-pointing bony projections (spinous processes) of the vertebrae and the arches (laminae) between them are exposed.

Strong muscles attached to the spinous processes are temporarily detached from the bone. Then, using bone cutters, the surgeon removes some or all of the spinous processes of two adjacent vertebrae and a sufficient portion of the lamina on each side of the disc protrusion to open access to the dura mater (the tough outer membrane) of the spinal cord.

The spinal cord, within its membrane, is carefully pushed aside to expose the damaged soft nucleus of the disc. The surgeon removes all of the protruding disc material. Sometimes, it is necessary to cut a thick ligament running along the spine.

In rare cases, it may also be necessary to remove the laminae of several neighboring vertebrae, which can make the back potentially unstable in bearing body weight. To restore proper spinal strength, a stabilizing titanium implant may be installed. To accelerate bone fusion, strips of bone may be taken from the iliac crest or another site and placed into grooves made for them.

Finally, the surgeon returns the muscles to their original position and closes the wound in layers, using absorbable sutures for the muscles and usually non-absorbable sutures for the skin.

WHAT HAPPENS IMMEDIATELY AFTER SURGERY?

Strict bed rest must be observed for 5-7 days. During this time, it is necessary to change positions as often as possible to avoid bedsores and to maintain muscle tone in the legs. There may be mild pain and tension in the back muscles until the effects of the surgical trauma subside. After about five to seven days, you will be encouraged to get up, and by that time, most of the muscle pain will have eased.

The recovery of full mobility and sensation (and in severe cases, control over urination) depends on how severe and long-lasting the neurological symptoms were—such as pain, muscle weakness and atrophy, loss of sensation, and loss of bladder control—caused by pressure on the nerve roots or spinal cord before surgery, as well as whether any nerve or spinal cord damage occurred during the operation. If all goes well, the patient may be discharged from the hospital after 11-12 days.

WHAT ARE THE LONG-TERM CONSEQUENCES?

It is necessary to sleep on a firm mattress, bend less often, avoid lifting heavy objects, and not sit for prolonged periods (such as on a bus or in a car). The degenerative processes that caused the herniation of one disc may later affect other adjacent discs.