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Low Back Pain and Failed Back Surgery

Back surgery is quite common in the United States with hundreds of thousands of operations performed each year. Sometimes these are laminectomies and diskectomies, and other times the spine is fused together so certain joints no longer move—a critical spinal function. The conservative medical approach/thinking to back pain is rest, medications, exercise, and physical therapy. If these fail, then epidural injections are often used. If there is little relief, at this point in the patient’s course, chiropractic care is usually not considered, and many patients follow the medical trajectory toward surgery.

Although many surgeons wouldn’t consider an operation to be effective for back pain, most patients think this is the primary concern for the surgeon. In reality, surgery is more indicated when the nerve root is compressed and there are neurological signs such as muscle wasting, foot drop, or numbness. If back pain is the primary problem and leg pain or numbness are absent, then surgery should generally be avoided.

However, most patients with leg pain will also have low back pain, and this low back pain can be quite severe. The patients who have this continued pain or numbness are called surgical failures. The term for this is failed back surgery syndrome. Entire medical conferences have been devoted to the topic/problem. Patients are left with few medical options after a failure and re-operation is especially problematic. The patient may be prescribed an opiate patch, or perhaps an implanted spinal cord stimulator, or both. These devices send electrical impulses through tiny wires that carry the signal to different areas of the spinal cord.

Sometimes these approaches work, but too often they don’t. By their nature, they cannot correct a joint problem. If you had a joint/disk injury before the surgery, it is likely it is still there. Post surgical cases should be evaluated by a chiropractor to see if there is an underlying joint problem that the can be adjusted specifically.

There may be some natural alternatives to electrical implants and long- term opiate medications for pain control. Certain physiotherapy, ice, exercise, and massage can be incorporated into a comprehensive drugless management program. Even counseling and behavior therapy can help to lessen the need for medications. Usually patients can be safely adjusted after the initial surgery has healed (about six weeks). It is important to consider all options before repeat operations. Active rehabilitation combined with specific chiropractic care can be the solution for many patients.


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