Limitations of Spine Surgery

It is natural for the patients to expect that they should become normal after the surgery. Many a times we see patients who do not get completely symptoms free after the surgery. This creates a discontent among the patients and discordance in doctor-patient relationship. Primary reason behind this is lack of understanding regarding nature of spine problems and lack of proper counseling before the surgery.

There are various sources of the spine pain and many of these are still not completely understood by modern medicine. As a doctor, we expect that after nerve decompression, symptoms coming from the nerve compression (neck pain/back pain, tingling, numbness, loss of sensation, weakness in upper/ lower limbs, loss of bladder-bowel control) should resolve. However, recovery doesn’t happen over-night. It takes a long time for the affected nerve to regain its function.

Recovery also depends on the amount of nerve damage, which has occurred prior to surgery. If the damage is irreversible, it may not recover. A major reason behind this is delay in surgery. However, in majority of the cases nerve damage is reversible and a gradual recovery spanning weeks-months can be expected, even in severe cases.

Similarly, when patients are suffering from discogenic neck or back pain, usually a fusion or disc replacement procedure is done. Basic philosophy behind this procedure is that the disc causing pain is removed and hence it is expected that neck/ back pain should resolve. In majority of the patients, surrounding discs are also degenerated to some extent. Even though they are not bad enough yet to get surgery, these can be source of persistent pain even though disc/ discs most affected are taken care of by surgery.

In certain patients, spine implants can irritate surrounding soft tissues and can cause pain after surgery. A healing scar tissue can also be painful. In addition, muscles can also cause pain if they are in spasm, are at mechanical disadvantage due to bad alignment of the spine, or if they are scarred.

A long standing back pain can also cause psychological changes. This might lead to continuation of symptoms even after the culprit pathology is treated.