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Back Pain - September '07
Back Revision Surgery: Relief when other methods fail
Hossein Elgafy, MD
Back pain can be excruciating and even disabling. Only a small percentage of people are candidates for back surgery, and learning about back revision surgery can alleviate anxiety and teach patients how to heal effectively.
Hossein Elgafy, MD, orthopaedic surgeon and assistant professor at The University of Toledo Medical Center, says there are many reasons for back surgery. “Some people experience extreme neck or back pain due to disc degeneration and/or complications from previous surgeries. Others have fractures, infections, tumors or arthritis in their back,” he says. “However, most of these patients can be treated without surgery.” Conservative treatment methods include medicine, physical therapy and local injection.
What causes of back pain could require surgery?
Discs are the soft tissue between vertebras that act as shock absorbers. They hold the vertebras together while allowing the spine to flex in different positions. If discs deteriorate, bulge or rupture, it increases the chance for the nerves that run through the spinal column to become pinched.
Although disc degeneration sounds like a daunting complication, it is quite common and often treated with conservative methods. In fact, some people never experience pain from disc degeneration. But when conservative methods fail, back and/or leg pain is not reduced and quality of life is affected, surgery can be a solution. Dr. Elgafy says fusion is currently the preferred method when surgery is necessary, but he is hopeful disc replacement will advance and become standard treatment.
The majority of patients Dr. Elgafy operates on have complications from previous back surgeries. “Pseudoarthrosis, adjacent level disease, inadequate internal fixation and disc degeneration are common complications that can occur from prior surgeries,” says Dr. Elgafy.
Pseudoarthrosis, which is a new joint that forms at the area where the bones don’t join together, occurs when a fracture or surgery doesn’t heal correctly. Adjacent level disease, which is damage to discs or joints in the surrounding area of a previously operated area in the spine, may require an additional back surgery. Inadequate internal fixation can occur when screws and rods from a previous back surgery do not heal properly or were not positioned correctly. Dr. Elgafy explains that inadequate internal fixation may also cause pseudoarthrosis.
Who is a candidate for surgery?
Since most back pain can be treated conservatively, determining candidates for surgery is a highly individualized process. Dr. Elgafy says orthopaedic surgeons begin by reviewing the patient’s medical history and talking with them about where they are experiencing pain. Next, a physical examination takes place along with other diagnostic procedures, including nerve studies, an EMG and CT scan. By reviewing the results, Dr. Elgafy and other spine specialists at UT Medical Center can determine if surgery is an option. “We assess each patient thoroughly to make sure we know where the pain is coming from and if surgery is going to be beneficial,” says Dr. Elgafy. “The last thing we would want is for the patient to still have pain after surgery.”
Maintaining a healthy back and spine
After surgery, Dr. Elgafy says it’s imperative that patients keep their back healthy. “Even if surgery is 100 percent successful and the patient is healed, 10 years down the road, complications can arise if the patient doesn’t take care of his or her back,” he says. Smoking can be detrimental to back healing because it causes poor circulation of blood in the spine. In fact, some surgeons won’t even conduct surgery if the patient doesn’t quit smoking. Maintaining a healthy weight and exercising are also important for maintaining a strong back and spine.
To learn more about finding a solution to neck and back pain, please call 877-451-2299.
