Over time, individuals dealing with chronic back pain often find themselves at a crossroads where the idea of undergoing back surgery becomes a consideration, despite the fears associated with such a decision. The enduring nature of chronic back pain can deteriorate one’s quality of life, limit daily activities, and lead to emotional strain. As the quest for relief intensifies, the idea of surgery may emerge as a potential solution, offering the promise of restored functionality and diminished pain.
That being said, back surgery is often considered a last resort. While these surgical procedures can provide relief and improved functionality for some patients, it’s essential to acknowledge potential drawbacks and risks associated with such drastic interventions. In this article, we will delve into the lesser-discussed side of back surgery, shedding light on the possible adverse effects that patients should be aware of before making an informed decision.
Introduction to Back Surgery
Back surgery, also known as spinal surgery or spine surgery, involves medical interventions that target the spine to address various spinal conditions, injuries, or chronic pain issues. The aim of back surgery is often to alleviate pain, restore spinal stability, improve mobility, and enhance overall quality of life. However, like any surgical procedure, back surgery comes with potential risks and complications that should be carefully considered.
Common Types of Back Surgery:
- Discectomy: Involves the removal of part or all of a damaged intervertebral disc that might be pressing on spinal nerves. It is commonly performed to relieve symptoms caused by herniated or bulging discs.
- Laminectomy: Also known as decompression surgery, it involves removing a part of the vertebral bone called the lamina to create more space within the spinal canal. This can help alleviate pressure on spinal nerves and the spinal cord, often caused by conditions like spinal stenosis.
- Spinal Fusion: A procedure in which two or more vertebrae are permanently joined together using bone grafts, screws, rods, or other hardware. This aims to stabilize the spine and reduce pain, often in cases of spinal instability, degenerative disc disease, or certain types of fractures.
- Artificial Disc Replacement: In this procedure, a damaged intervertebral disc is replaced with an artificial disc to maintain spinal motion and flexibility. It is an alternative to spinal fusion and is usually considered for carefully selected patients.
- Vertebroplasty and Kyphoplasty: These minimally invasive procedures involve injecting bone cement into fractured vertebrae to stabilize them. They are commonly used to treat vertebral compression fractures caused by conditions like osteoporosis.
- Foraminotomy: Involves enlarging the openings (foramina) through which spinal nerves exit the spinal column, often performed to relieve pressure on compressed nerves due to conditions like foraminal stenosis.
- Microdiscectomy: Similar to a standard discectomy, microdiscectomy is a minimally invasive procedure that involves removing a portion of a herniated disc.
- Minimally Invasive Spine Surgery (MISS): This is a general term for various procedures performed using small incisions and specialized tools, aiming to reduce tissue damage and promote faster recovery compared to traditional open surgeries.
Complications and Risks
Failed Back Surgery Syndrome
According to the definition provided by the International Association for the Study of Pain, failed back surgery syndrome (FBSS) is characterized as persistent lumbar spinal pain with an uncertain cause. The pain may originate after surgery, or the surgery may exacerbate or insufficiently alleviate existing pain.
The potential for failed back surgery syndrome is heightened by risks from activities and events that occur within the operating room while the surgery is ongoing, such as operating on an incorrect vertebral level or focusing on a single level while the pain source extends across multiple levels. This can result in inadequate pain relief and suboptimal outcomes. Factors contributing to the identification of the wrong vertebral level include variations like lumbarization, sacralization, and particularly when pain arises from an elusive pathology. These intricacies highlight the difficulty in accurately pinpointing pain in patients with alterations spanning multiple segments. Inaccurate surgical techniques can also lead to insufficient pain relief or the onset of new pain sensations.
The trajectory toward failed back surgery syndrome can also be influenced by long-term complications arising from surgery, which may be avoidable or inherent. Surgical interventions can exacerbate pre-existing symptoms or introduce new ones by inducing spinal stenosis, spinal instability, epidural fibrosis, or disruption of adjacent intervertebral discs. These complications further contribute to the complex landscape of failed back surgery syndrome in certain patients.
Loss of Mobility and Functionality
Muscle weakness and atrophy are relatively common postoperative complications after back surgery, especially in procedures that involve significant manipulation of the spine or adjacent muscles.
One of the primary reasons for muscle weakness and loss of mobility is bed rest. During the recovery period, patients limit their physical activity to avoid strain or just out of fear of aggravating the discs. The reduced activity level leads to a decrease in muscle usage, resulting in muscle tissue loss and weakness over time.
Also, surgical procedures on the spine carry a risk of damaging nearby nerves. Nerve damage can disrupt the signals between the nerves and the muscles they control, leading to muscle weakness and even paralysis if severe.
Psychological Effects
Chronic pain, especially when associated with conditions such as failed back surgery syndrome, can lead to the development or exacerbation of depression and anxiety.
Depression after back pain is not uncommon. A 2017 Mayo Clinic study shared that “Patients who undergo spinal surgery have a higher risk for postoperative depression than patients treated for other surgical or medical conditions known to be associated with depression.”
This is mostly due to the reduced mobility following back surgery. The loss of functionality often leads to frustration and a sense of dependency on others. For some, the inability to engage in activities they once enjoyed can lead to a loss of their sense of self and identity.
Long-Term Effects on Spinal Health
Despite successful surgeries, some patients may experience pain persistence or recurrence due to various factors such as incomplete nerve healing, scar tissue formation, or nerve damage that can’t be fully reversed.
Hardware Fracture
In many different types of back surgeries, there are metal screws, plates, and rods that are used as part of the procedure that helps hold the vertebrae in alignment while the spine heals. They are called “hardware”, and once the bone heals, the hardware serves of no use. There is a possibility that the hardware moves or breaks before the spine is completely healed. This is called “hardware fracture” and if it occurs it may require a second operation to replace the hardware or to remove it.
Conclusion
In conclusion, while back surgery can offer hope and relief to individuals suffering from debilitating spinal conditions, it also comes with potential negative effects that must be carefully considered. From the risk of surgical complications to the uncertainty of long-term outcomes and the possibility of failed surgeries, there are genuine concerns that warrant thorough exploration and discussion with medical professionals. Patients must educate themselves about the potential risks, benefits, and alternatives before making a decision. Non-invasive treatments, lifestyle adjustments, and second opinions should be explored whenever possible. Ultimately, each case is unique, and the decision to undergo back surgery should be based on a well-informed assessment of individual needs, preferences, and medical advice.