Failed Back Surgery Syndrome
Do you still have pain after back surgery? Have you been diagnosed with "Failed back surgery syndrome." There are several reasons why a patient may still have pain after back surgery.

Did the surgery make your spine weaker?
One reason is that a surgeon may remove part of a bony vertebra as in a laminectomy if they think it is pressing on a nerve. This may solve the original problem but the body “fills in” the removed bone with scar and other tissues which of course is not as strong as bone. This leaves an area of weakness that may be the source of future pain, especially if it is an area that receives a lot stress. Repetitive bending and twisting puts a lot of stress on the low back, for example.

Did the fusion surgery cause problems above and below the fused section?
A spinal fusion patient will usually do well for a time if their pain was due to spinal instability, but we do see spinal fusion patients whose back pain returns. The pain may be above or below the vertebrae that were fused together. Why, you ask? Well, if you have an area of the spine that cannot move anymore because it is fused, and you still are getting in and out of beds, cars and chairs, in other words, living your life, flexibility in your spine and pelvis that allows you to do these things has to come from somewhere. This somewhere is above and below the fusion which puts added stress on the ligaments, muscles and discs in these areas leading to degeneration, weakness and pain.

Alternative Treatment Options for Failed Back Surgery Syndrome
We use the term “weakness” frequently at Caring Medical. One of our definitions of pain is weakness, especially when it pertains to ligaments. Prolotherapy is the injection treatment that Dr. Hauser uses to help repair weak and damaged ligaments. Ligaments are bands of fibrous tissue that connect bones to each other, like the vertebrae to each other and the sacrum to the pelvis. The sacrum is the part of the spine below the fifth and last lumbar vertebrae and above the coccyx. The uppermost portion of our pelvis is called the ilium. The area that connects these structures is called the sacroiliac joint, (SI) sacro from the sacrum, iliac from the ilium. There is an expansive mesh of ligaments that make up this sacroiliac joint which is frequently injured. The function of the SI ligaments and the ligaments of the spine is to provide stability to these bones while allowing normal motion to occur. You can injure these ligaments by taking a spill on the ice, for example, but we see a lot of sports injuries where the athlete puts a lot of stress on these structures. Imagine the thousands of low back twists during serve that an avid tennis player performs in a year, let alone a lifetime.

It is really sad to say, but some of the people we see with FBSS have it because they probably never should have had the surgery in the first place, meaning the so-called damaged structure the surgeon was trying to fix was not the cause of their pain in the first place. Many people, doctors included, do not know that a damaged ligament in the spine can cause sciatic or nerve pain down the arms or legs. A ligament can become damaged or overstretched (lax) from a fall, repetitive activities like bending and twisting, and some people are born with congenitally lax ligaments. Many people felt it was common knowledge that sciatic pain down the legs or nerve pain down the arms was from a pinched nerve related to a herniated disc or overgrowth of vertebral bone. However, our experience, along with many targeted research articles showing the common prevalence of disc problems in the general population, reveals that there has to be something else going on with these patients. The research shows that most people over the age of 40 have some type of disc problem, as viewed under MRI.However, since most people over the age of 40 do not have back pain, there may not necessarily be a direct correlation between disc abnormalities and back and or referred pain down the extremities.

Hackett referral patterns of pain from ligaments, as mapped by Dr. Hackett decades ago make a lot of sense. Dr. Hackett was a founding father of Prolotherapy who brought regenerative injection therapy from the field of hernia-ology to the field of joint repair. He mapped out referral pain patterns that emanated from ligament injuries. They were very similar to the pain patterns associated with pinched or compressed nerves in the spine. So when someone comes in to Caring Medical, their original scans show disc or nerve problems, problems were surgically repaired, and yet the patient still has pain…we suspect ligament damage or weakness. We usually can rule out muscle injury as the cause of pain as they tend to heal fairly quickly. Muscles have a large blood supply which brings the healing effects of the immune system to bear. Bone injury or cancer is fairly easy to diagnose with the appropriate scan. It is difficult to diagnose an injured or lax ligament via any type of scan unless it is completely torn, and they are slow to heal when injured because unlike muscles, they have a poor blood supply. You can see why people sometimes wind up having surgery on a structure like a disc or vertebra that was thought to be the source of their pain. In retrospect, they should have had a treatment that strengthens a damaged ligament, like Prolotherapy.

Prolotherapy
At Caring Medical, we review an FBSS patient’s surgical report and perform a physical exam. If the physical exam and oral history confirms low back or pelvic instability due to ligament injury, then he will inform the patient that Prolotherapy would be a good treatment option to correct this underlying cause of their pain. For example, if the ligaments are injured and not holding the pelvis or vertebrae in correct alignment, nerve impingement may occur, or muscles may abnormally contract in their effort to stabilize the area, which can cause pain in the back and/or extremities, even after a surgical disc repair. Also, in response to an unstable area caused by ligament laxity, a person may begin to walk or exercise in a compensatory manner, placing abnormal stress on other areas of the body which can cause degeneration and pain in structures not directly related to the back.

 

The Journal of Prolotherapy

Prolotherapy research at
The Journal of Prolotherapy