From professional golfer Tiger Woods’ multiple spine surgeries dating back to 2014, to Golden State Warriors head coach Steve Kerr’s failed back surgery in 2015 and its resulting complications, a very bright public spotlight has been placed on the efficacy of spine surgery. The understandable question on many an “average Joe’s” mind is: If it didn’t work for them, how can it possibly work for me? The answer to that question requires a much deeper exploration of the intent of spine surgery and the many considerations required of both the surgeon performing it and the patient undergoing it.
First, it’s important to point out that success stories abound for many people who have experienced enough spine trouble to lead them down the path of exploring surgery to fix it. Some credit their new pain-free life to their spine surgeon after a successful surgery because they believe they’ve been given a second chance at a fully functional life. These quality of life transformations are awe-inspiring, and as a spine surgeon, these stories of success are my greatest victories and deepest sources of inspiration.
Though I have made spine surgery my career and have utmost confidence that a successful operation can change someone’s life for the better, the fact remains that sometimes spine surgery does fail. Now, you may be thinking, why would a spine surgeon tell me this? The answer is simple: honesty. The truth is, there are many reasons why a spine surgery may or may not work, and it’s my job to ensure that every one of my patients and the public, who may be considering surgery, thoroughly understands the benefits and risks before deciding on any type of spine treatment.
When spine surgery fails, people want to know whose “fault” it is. Is it the surgeon’s? The patient’s? Was there not enough preparation? Or is it all up to chance? What is it that makes a successful or unsuccessful spine surgery outcome? Let’s explore.
One crucial piece of knowledge to gain on this topic is that spine surgery cannot physically make the spine normal, because pain is a subjective symptom and may be functional or coming from true structural causes because of whatever is wrong with the spinal anatomy. This change in spinal anatomy is commonly the result of wear and tear of the structures. The surgeon, therefore, can address a couple basic things. He or she can remove any areas of compression of the spinal nerves and, secondly, stabilize an area that is inherently weak or unstable. This helps relieve pain and provides for better spine stability and structure, in turn helping restore function.
Decompressive surgery in itself helps relieve pressure on a compressed nerve, but if there is gross instability that’s not addressed, that micromotion may be responsible for persistent or recurrent pain. Therefore, accurately identifying the probable cause of the pain is imperative for spine surgery to be successful. One of the biggest reasons for an unsuccessful surgery and continued postoperative pain or other complications is that there are many areas this pain could be coming from. There are five mobile discs in a lumbar spine, and if one is showing degenerative changes of wear and tear, it’s certainly likely that the others also have some degree of degeneration, but just not as bad. An analogy I often use with patients is that there are four tires on a car, and even though only one tire gave out, we know that the other tires ran the same number of miles and could give out at any time too. Seems simple enough, right? Almost too simple to exist as a risk factor, but some spine problems are more reliable than others in terms of predicting how well mending them will reduce a patient’s symptoms of pain.
For instance, performing a discectomy on a lumbar disc herniation that is causing leg pain is often a more predictable operation than the same procedure performed to treat a herniation that is causing lower back pain. The same applies to spinal fusion surgery: to repair spinal instability, it’s met with large success, yet to repair lumbar degenerative disc disease, it may be less likely to be successful.
Spine surgery success can also depend on how long the patient has been suffering from the spinal condition in question. When the health of one part of the spine deteriorates, it can create a cascade effect that places stress on and weakens other parts. An example here is that after surgery to repair a herniated disc, a patient may feel substantial relief from pain and consider the surgery a success, only to experience an acute resurgence of pain that would likely indicate another disc herniation has occurred. Experiencing a second (or third) herniated disc is not an uncommon cause of recurrent back pain, and though the initial injury may have been repaired, reemerging pain can make it feel as though the surgery was unsuccessful.
Technical error or hardware malfunction can also account for failed surgery. In the case of discectomies, if any trace amount of disc material or bone fragment is left behind, it may continue to irritate the surrounding nerves, and though it may be less severe than before the surgery, can still be the cause of pain. In other instances, such as spinal fusion surgery (where the vertebrae are prepared to be fused together), the surgeon can execute all of his or her plans to the greatest accuracy – and still, for some reason, the bones may not fuse completely solid. This is a physiological function of the body and unfortunately out of a surgeon’s complete control.
Complete back surgery success does not favor any one surgeon or patient. Even for professional athletes and coaches who are equipped with paramount care and the highest ranked doctors, there is no higher guarantee for their success than anyone else’s. Though there are some factors that are beyond any surgeon’s or patient’s control (and we both must knowingly accept these possibilities before surgery) there are some things you can do to ensure the best chance at spine surgery success.
Ensure that you have chosen a surgeon and facility that have the right track record and appropriate resources and staff available to you through every step of your treatment. Do research, read reviews, listen to what others are saying and don’t be afraid to ask questions. Feeling confident with the surgeon you choose and comfortable with the facility and staff is the first step to getting on the right track for success. After the behind-the-scenes work is complete, focus on you. The patients who are most prepared for surgery almost always have the best outcomes. If advised, lose weight (even if that means just a couple pounds – every little bit helps), quit smoking, continue moderate exercise up until the date of surgery, don’t make any changes to medications unless specifically instructed by your surgeon and above all, try to relax. It may not seem like much, but reducing extra stressors in the days leading up to surgery can help keep your body in tip top shape – a success factor for a healthier recovery.