Pain after back or neck surgery
September 13, 2019
After back or neck surgery, one is expected to have soreness and tenderness as well as some restriction of motion. This article will discuss common and uncommon types of pain after neck or back surgery.
Neck Pain after Surgery
As far as neck surgery is concerned, if a patient has radiculopathy with weakness and numbness and pain in the arm, if a cervical spine fusion is done, then that cervical spine radiculopathy goes away.
Soreness in the neck goes on for two to four weeks and resolves on its own. If one operates on the cervical spine for just a degenerative disc, ie; an MRI image based diagnosis and no radiculopathy that’s clinically relevant, then neck pain will persist afterwards. The statistical percentages show only 35% of people with neck pain and have a fusion actually get better. That means up to 65% of patients who have a neck fusion have continued pain. The message here is clear, for patients with this type of neck pain, surgery should be avoided. Anti-inflammatory medication and a focused physical therapy program is important.
Some of the differential diagnosis are:
- neck extensor weakness (as your head weighs 10 or 15 lbs)
- scalene syndrome where the muscles in front of the neck which attach to the 1st and 2nd rib pinch the brachial plexus causing numbness and tingling in the hand but not in a radicular sense.
What happens is, if a surgeon operates on these people and the symptoms persist, this will lead to an incorrect diagnosis and a flawed end result with pain after surgery. Remember, pain after cervical spine surgery in the arm (if done appropriately) should not exist.
Back Pain after Surgery
I’d like to talk about lumbar spine surgery. Depending on the cause of lumbar spine pain, a degenerative disc, which is discogram proven, and facet arthropathy are two things that cause back pain. Spinal Stenosis can cause back pain. Now if you have pure leg pain, from a herniated disc or pressure on a nerve root, and a surgeon performs a surgery for that, the leg pain should go away as long as the diagnosis is correct. Therefore there should be no residual leg pain after a spine surgery, whether it be a laminectomy or a fusion. If the diagnosis is correct in the lumbar spine and the facets, the degenerative disc, or spinal stenosis is the source of pain, with the right surgery, those pains will go away. This also includes a spinal fusion with instrumentation.
In my patients over the last 30 years, I have found by the second or third week, no narcotics are needed, no opioids are needed, and activity as tolerated is encouraged. A back fusion takes 6 weeks up to 12 weeks to fuse entirely and only then should physical therapy begin. If physical therapy is performed too soon or inappropriately, then back pain can occur. If back pain and leg pain are 50/50 as far as problems and the surgery is performed, the leg pain should go away and the back pain should go away in 3-6 weeks. Any longer that, one would be suspect as having a surgery that wasn’t done appropriately or for the wrong diagnosis.
Conclusion
I would cite Tiger Woods history. You can check out my article and video about Tiger Woods to learn more on this topic. The long story short is with an appropriate diagnosis and appropriate surgery, there is no neck or back pain after surgery if done correctly. Remember pain is a symptom, it’s not a diagnosis. If your car is in the parking lot and it doesn’t start, you don’t just go change the battery. You need to find out what’s wrong. If you change the battery with a surgical procedure that is not appropriate for the diagnosis, then you will have pain afterwards. Physical Therapy plays a big part in preventing these surgeries and that should be exhausted correctly first.
