There are occasions where lower back surgery may be necessary for an injured disc or stenosis of the spinal canal. Statistics demonstrate that a reoccurrence of lower back pain within 5 years post surgical is not uncommon. Research has shown that between 5 and 30% of post-surgical patients experience recurrent lower back pain. A large percentage of this group will have leg pain with the back pain. While the surgery was successfully done, symptoms may persist or reoccur. This condition is called Failed Back Surgery Syndrome or FBSS. Can conservative chiropractic management be helpful in the care and treatment of this condition? The answer is yes, in many, but not all cases. It may be necessary to work with a team approach for the management of FBSS. This article provides information on chiropractic intervention and management of FBSS. Post Surgical Continued Pain has been used by some authorities to refer to this post surgical condition.
What is a Failed Back?
A failed back occurs when patients continue to have chronic lower back pain or fail to improve after spinal surgery. Pain may or may not extend into the extremities. Spine surgeries have been estimated to occur between 600,000 and 1,100,000 interventions per year in the United States. If up to 30% of the patients do not improve, the result is ongoing lower back or lower back and leg pain in spite of the surgery. A review of literature found that the number of surgical interventions on lower back problems in the United States rose from over 300,000 in 1994 to nearly 393,000 in the year 2000. Also, it was noted that fusion of the lumbar spine increased 220% from 1990 to 2001. It was estimated that up to 60% or more of initial lower back surgeries were successful and had a great outcome. The remaining back surgeries are consistent with the 30% who do not improve or are worse. A study from 1990-1993 in Washington State revealed that approximately 19% had to have a second surgery for complications over the following 11 years. If these estimates are correct, this may result in 80,000 failed back surgeries every year. Recent review of the published data on FBSS confirm these statistics to hold true over time. The clinical and economic impact of this problem is immense to the patient, family, business and society. Symptoms of FBSS may include:
- Lower Back Pain
- Leg Pain
- Lower Back and Leg Pain
- Numbness and Tingling in the Leg(s)
- Dull Ache or Prickling Sensation in the Back and Leg(s)
What can Happen to the FBSS Patient?
Many of these patients have other biomechanical or structural problems that may be contributing to the back or the back and leg pain. These may include:
- Sacroiliac Dysfunction – Commonly stated as a “slipped sacroiliac”
- Disc Herniation – Above or below the surgical repair
- Degenerative Joint and Disc Disease
- Foraminal or Central Canal Stenosis – A narrowing where the nerves and spinal column travel
- Biomechanical Dysfunction – The vertebra above or below the surgical repair when the vertebra are not moving and gliding properly with spine movement
- Facet Syndrome
- Post-operative Fibrosis and/or Arachnoiditis
- Failure of the Bones to Fuse or Unite – This forms a false joint
- Poor Sleep Habits
- Poor Muscle Tone – Post surgery
- Smoking – Post surgery during the repair process
- Unrealistic Expectations – Post surgery contributing to psychosocial issues
Not all of these issues can be successfully managed with only chiropractic care. Conditions with the facet joints, degenerative joint disease, sacroiliac dysfunction, biomechanical dysfunction of the adjacent vertebra and disc herniation may be the most amenable to chiropractic care. Co-management with other health care professionals may be necessary in some cases. It is recommended that chiropractic care not begin until 3 months post surgical. This assures that all the healing from the surgery has taken place.
How can Chiropractic Help the FBSS Patient?
Failed back or post surgical patients may benefit from a multidisciplinary approach to care for the condition. Coon Rapids Chiropractic Office uses two primary treatment protocols for FBSS. Flexion-Distraction is a safe and researched chiropractic technique. High Velocity Low Amplitude (HVLA) is commonly called diversified technique that is the most common chiropractic treatment. The type of treatment that is given is determined by the type of surgery and the doctor’s examination findings. Additional treatment recommendations may or may not include all of the following:
- Physical Modalities – Use of ultrasound and or electrical muscle stimulation to help in muscle relaxation
- Exercise – Core strengthening to focus on abdominal and lower back muscles
Using basic warm up exercises with the Swiss or physioball will help prevent possible aggravation of an injury or your condition. “Warm-ups” prepare the body for the exercise activity. The following video is an excellent start to your ball exercise program. These can begin as soon as your doctor gives the recommendation. Never work through the pain, stop at the point the pain increases.~ Dr. James R. Brandt
- Co-Management – Cooperation among the health care disciplines that include a multiple management approach with a team goal to return the patient to normal activities of daily living
- Goal Setting – Setting a realistic goal of 50% improvement of pain and dysfunction
- Determine Treatment Timeframe – Set a reasonable timeframe of treatment that limits the possibilities of treatment dependency
Chiropractic care is a reasonable option for a trial period of treatment for patients with post surgical pain or FBSS. Realistic expectations by both the doctor and patient are essential. Cooperation during the treatment timeframe will help with obtaining possible success in controlling and managing the pain. If chiropractic care fails to correct biomechanical problems and the pain has not been reduced by 50%, a referral back to the surgeon or an interventional pain specialist is recommended. The treatment modalities used by these physicians in this situation is beyond the scope of this article. These treatment options can be discussed with your chiropractic or medical doctor.
The doctors at Coon Rapids Chiropractic Office have experience with the care and treatment of post-surgical or FBSS patients.