Features January 2010 Issue

Boost Your Odds of Successful Back Surgery

Having back surgery doesn’t guarantee you’ll be pain free. But there are things you can do to position yourself for success.

Having surgery on your spine doesn’t mean you will be without pain forever. The term "failed back surgery syndrome" was coined to describe the condition of patients who fail to have significant improvement in the targeted symptom—usually pain—within a reasonable period of time after surgery, according to Daniel Mazanec, MD, vice chairman of Cleveland Clinic Spine Institute and head of the

Section of Spine Medicine.

"Failed spine surgery does not describe somebody with a lumbar disc herniation who has surgery, is in great shape for 10 years, and then experiences pain again. Usually, it’s someone who has surgery and then symptoms recur within six months to two years." Studies suggest the syndrome occurs in between five percent and 40 percent of surgeries, depending on who’s doing the estimating and how the syndrome is defined. Regardless, it’s a significant problem that you’ll want to take steps to avoid.


Why surgery fails

There are two primary reasons that spine surgery fails, Dr. Mazanec explains. "The more common reason is that what has been surgically treated was not really the cause of the symptoms to begin with. For example, a surgeon operates on your disc or performs a fusion or some other procedure aimed at relieving the symptom. There’s nothing technically wrong with the surgery, and afterward, the X-ray or imaging looks better, but what was fixed was not really the cause of the pain and the patient ends up disappointed." This happens more commonly with surgery for back pain than for leg pain, Dr. Mazanec observes.

The other reason for failure is a technical glitch in the surgical procedure—for example, the surgeon fails to successfully fuse vertebrae in a spinal fusion, and pseudoarthrosis (movement between the bones) occurs. Or hardware ("instrumentation") problems occur. "The surgeon may place a screw too close to a nerve root, and you end up with a symptom you didn’t have before surgery. Or the hardware can break because the surgeon has not placed correctly," Dr. Mazanec explains.


Prepare for success

If you’ve exhausted other options for treating back pain and decide to have surgery, there are a number of steps you can take to improve your odds of a successful outcome. Dr. Mazanec recommends the following:

• Set realistic expectations. "If you have leg pain and back pain, be aware that surgery is better at relieving leg pain. So if you think your back pain will be Back Surgery

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gone and it’s not, you may consider thesurgery ‘failed’ even if your leg pain is relieved."

• Quit smoking at least six weeks before surgery. Active smoking reduces the success rate for spinal fusion by half. The same is true of nicotine patches and similar products, because nicotine hampers circulation.

Get a second opinion before having surgery. "Surgery is an art, and medical experts have differing opinions not only about whether to operate, but what to do, how much to do, and how to do it. If a large surgery is proposed, you certainly want to make sure it’s right for you."

Tell your surgeon about any medications and supplements you’re currently taking. Supplements such as ginkgo, ginseng, and ginger can affect coagulation—the blood’s ability to clot. Drugs such as tricyclic antidepressants can cross-react with drugs used in the anesthetic process.

Choose an experienced, fellowship-trained spine surgeon. "It’s not just the number of surgeries performed, but the frequency of surgeries that counts," Dr. Maza-nec says. "Does the surgeon do a spine operation every six months or, say, 12 a week?" A surgeon who has completed a fellowship generally has had an additional year of training, specifically in spine surgery.

Exercise and lose weight, if necessary, before surgery. Good health going into surgery improves the chances of a good surgical outcome.

After surgery, "the key is to follow the guidelines provided by the surgeon and the surgical team," Dr. Mazanec stresses.