When Pain Returns
WHEN PAIN RETURNS: ADJACENT SEGMENT DISEASE
A reality of spine fusions is that sometimes when one disc level is fused and corrected, another adjacent level begins to be the cause of back pain. Fusion can lead to stress at the joint above or below. The percentage of patients that require adjacent disc treatment has lessened, and will likely continue to decrease with continued advancements in spinal surgery.
THE PAIN NEVER LEFT: NON-UNION
Experiencing a non-union, or pseudoarthrosis, means the vertebrae that the surgeon intended to have joined together does not, thus continuing the same back pain previously experienced. This might be a result of factors out of the doctor’s control, such as smoking or osteoporosis. If you experience this sort of pain, you doctor will likely approach treatment initially with conservative options but might eventually have to suggest a revision surgery if conservative approaches fail.
Sometimes the best treatment is to continue with medicine, physical therapy, increasing activities, and having no further surgery. Other times, the best treatment is another surgery. The best treatment may be with some more advanced pain management technology, such as, the placement of a spinal cord stimulator for patients who have ongoing severe nerve pain, but are not a candidate for surgery.
THERE IS MORE THAN ONE SOURCE OF PAIN
It is possible that a patient had more than one cause of pain at the time prior to surgery and after one was treated, there remained the other cause of pain. It is not uncommon to have multiple diagnoses for back pain. For example, over 30% of patients with low back pain also have some accompanying sacroiliitis, which can contribute to back pain. Other common additional diagnoses might include: sciatica, arthritis, or disc degeneration.
In any event, reevaluating continued pain or chronic pain, even in the patient who has had previous surgery, can also lead toward a more precise diagnosis of a pain generator that can subsequently be offered treatment. With a good diagnosis, with a better idea of where the pain can come from, a more precise treatment can be offered. It can often help a patient with ongoing pain.