Spine surgery doesn’t cure everyone. The failure rate is highest in the lower back, probably because it carries more of our weight. However, since most people do get significant improvement with surgery, I always worry and try to find out why some patients don’t do well. Some of the possibilities are:

Recurrent/residual disc herniation – at surgery, even with the microscope, we can’t see all of the back of a disc and can’t go more than ½ inch above and below the disc without taking off a lot of lamina. Sometimes a piece of disc has migrated up or down or across or even way out laterally and we don’t see it. Therefore, if patients are getting better after six weeks, an MRI scan is recommended. Some patients will do great for a few days or weeks, then suddenly have pain again. Usually it’s swelling but it can be another piece of the disc coming out. Early recurrences are usually at the same place. I wouldn’t call a late recurrence after six months, or a new herniation at another level or on the other side a failed surgery.

Hematoma – sometimes bleeding occurs after the patient is moved off the operating table or later gets up and moves around. That can cause pain. If it continues, nerve damage can occur and reoperation is needed

Infection – back pain, usually without leg pain, that comes on several weeks or a few months after surgery could be from a deep infection in the back. Blood tests and an MRI scan will rule this out.

Stenosis or instability – sometimes, although rarely, vertebrae will slip a little or arthritis will set in to cause pain after a formerly successful operation.

Hip Arthritis or Bursitis – a constant problem is whether pain in the hip and groin area is from the back or the hip. Sometimes with relief of back pain and stenosis, patients get more active and then realize their hip is a problem.

Poor patient selection – hopefully these are patients operated on elsewhere. Some of them have issues that indicate it was poor judgment to operate on them or that they had more done than necessary, such as a fusion. Fusions except in spondylolisthesis or traumatic fractures can leave patients in chronic pain.

Scar tissue – I don’t think this is a cause of failure in back surgery. Patients who do well will have scar tissue as part of normal healing. Often when we do a post-op scan and can’t find anything to explain continued pain, we fall back on blaming it on scar tissue.