Why am I Still in Pain After Spine Surgery?

PART ONE

How come I’m still in pain after spine surgery? It’s a common question, and the answer depends on the type of surgery and when you ask.

The first couple days after surgery, it is typical to feel pain.  During surgery,  medications such as steroids are infused into the area to help reduce swelling.  The medication eventually wears off  but your body continues to heal itself.  During this initial healing phase, you will notice quite a bit of inflammation which may result in increased pain. 

Usually, this is a temporary set back.  As you heal, your body reduces the swelling and it should become less painful.

For discectomy surgery,  the nerves may need to be moved away from the site of disc herniation.  This can stretch the nerves and, for a small percentage of patients, this stretched nerve can cause numbness, pain, or even weakness of the muscles associated with that nerve.  For the vast majority, this resolves over time.   

During surgery,  the manipulation of the nerve may have the unintended effect of further irritating it. This can cause the swelling to worsen and result in increased pinching of the nerve.  So although the herniated disc or bone spur is removed, the nerve is still irritated.  The nerve should eventually return to its normal size but if the pain persists, contact your surgeon to let them know.

For fusion surgery,  the bone edges need to be scraped to promote bleeding. The additional blood flow is necessary for the fused bones to heal.  As explained in a previous blog,  fusion is a process that results in the body treating two bones as one,  similar to a broken bone.  Understandably, this scraping can be a source of pain.  However, as the fused bones mature,  it should become less painful.  

A combination of rods,  plates, and screws are used to hold the bones in place while fusion takes place.   Before it’s complete, the bones may still move around and continue to cause you pain.  However, once fully fused, your condition should improve.

For some people, the immediate relief following spine surgery is short-lived.  As your body heals, scar tissue will form on your nerves and this may cause you pain when you make certain movements. Further testing can reveal increased scarring of the nerves. The scaring tethers the nerves, causing pain with motion.  If this is the case, every attempt should be made to stretch the scar with exercise — as this will allow more give to the tissues, and allow you to move without pulling on the nerves.  Unfortunately,  additional surgery to free the scarring will just result in more scarring.  

For some people, the scarring associated with the incision, along with the atrophy of the muscles dissected during the operation can be a source of pain.

For all surgery patients,  the pain from having surgery can take several weeks to resolve.  Most of the time,  any increased or lingering pain is temporary.  Most of the time,  the surgery itself is successful and you just need to give your body time to recover.

However, for some, the source of pain might warrant serious concern.

Next week’s blog will follow up on this topic and discuss the most common complications in spine surgery.

Last modified: October 15, 2020