Rheumatology’s role: This is usually a mechanical or nerve-related spine condition treated by our pain and spine physicians. A rheumatologist may be involved when there are signs of inflammatory arthritis, such as morning stiffness, swelling in several joints or abnormal inflammation tests.
For full details on this condition, see our main page: Failed Back & Neck Surgery.
Overview
Some people continue to have pain, or develop new pain, after spine surgery. This is sometimes called failed back surgery syndrome or persistent spinal pain syndrome. It does not necessarily mean the surgery was done incorrectly.
Possible reasons include scar tissue around nerves, changes at neighboring spinal levels or nerve damage that existed before surgery. A careful evaluation helps guide treatment, which may include therapy, medication, injections or neuromodulation.
Watch and learn
Video: “Spine Stimulator for Pain” from Mayo Clinic on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube
Captions: press the CC button in the video player to turn on captions. Some captions are generated automatically by YouTube and may contain errors.
Common symptoms
- Back or neck pain that persists after surgery
- Leg or arm pain, burning or numbness
- Pain that returns after a period of improvement
- Reduced ability to walk, sit or work
Causes and risk factors
- Scar tissue (epidural fibrosis)
- Recurrent disc herniation
- Adjacent segment degeneration
- Nerve injury
- Persistent stenosis or instability
How it is diagnosed
Diagnosis usually starts with a conversation about your symptoms and a physical exam. Depending on what we find, your clinician may order X-rays, an MRI or CT scan, or nerve tests. Imaging findings are interpreted together with your exam, because many people have changes on an MRI that do not cause pain. Records from your previous surgery and imaging are very helpful.
Treatment options
Self-care and lifestyle
Paced activity, walking and sleep and stress skills may help when pain continues after surgery.
Physical therapy and medications
Physical therapy and a medicine review, including nerve pain medicines, are usually part of the plan.
Injections and nerve blocks
Epidural injections or nerve blocks may help when a nerve is irritated.
Minimally invasive procedures
Spinal cord stimulation, DRG stimulation or an intrathecal pump may be options for persistent nerve-related pain.
Surgical evaluation
A spine surgeon may evaluate for problems such as adjacent segment disease, instability or recurrent compression.
Frequently asked questions
Can I be helped if surgery did not relieve my pain?
Many patients have options. Neuromodulation, such as spinal cord stimulation, is commonly considered for persistent leg or back pain after surgery.
Do I need another surgery?
Not necessarily. Further surgery is considered only if a specific correctable problem is found.
What should I bring to my visit?
Bring your operative report, recent imaging reports and discs, and a list of treatments you have tried.
This page is general patient education and does not replace advice from your own clinician. Individual results vary.