Failed Back Surgery Syndrome treatment options

Ross Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C.

You are likely reading this article because you are looking for some answers to your diagnoses of failed back surgery syndrome. You have probably been told that many people have very successful surgeries, and that is very true, but failed back surgery complications is something that does happen and that you need to move forward from here. Moving forward may be difficult for you as your pain can be significant or bothersome and it is compromising your quality of life. Although your back pain may not be as severe as it was before the surgery, you like many will continue to experience significant back pain after spinal surgery. Why? Because the back surgery involved removing supporting structures, such as a lamina, facet, or disc, weakening their spinal structures. As you will see in the research below, doctors are being told to inform patients of the substantial likelihood of re-operation following a lumbar spine operation. Later in this article, we will present non-surgical treatment options to help you with your back pain.

If you would like help from our staff on the assessment of your condition, please email us.

What are we seeing in this image?

Spinal instability at the L3-L4 segment above a previous L5-S1 fusion.

In patients we see, Prolotherapy injections would be recommended for appropriate candidates where a realistic expectation of 90% pain relief (curative) may be achieved. This is not attainable in all patients and is not typical. But for appropriate candidates, significant pain relief can be achieved.

Successful failure, failure of a successful surgery, which one are you?

We would like to remind our readers that people have very successful spinal surgeries. These are the people that we do not see at our center, we see the people who did not. These simple stories go something like this:

Failed lumbar fusion at L5-S1

Dear Caring Medical, I have failed lumbar fusion at L5-S1. The fusion did not help alleviate my chronic pain which is sometimes severe and debilitating. I’m hoping to eliminate or manage the pain in my back to allow for normal daily functioning like sitting, driving, walking, and standing.

The surgery was a success, I still have pain

“My surgeon said my L5-S1 fusion surgery was technically very successful. Unfortunately, scar tissue has developed and is pressing on my nerves.”

“My surgery was very successful, but I have spinal muscular atrophy as a result and weakness in my spine.”

“My surgery did not go well. I have had several surgeries since. I am on nerve blocks, pumps, pain meds.”

When people contact us, we have to have a realistic expectation that we can help them. If someone had a broken screw, a crooked rod, or any other hardware failure, the hardware issues need to be addressed with their surgeons before a discussion of avoidance of further surgeries can be discussed.

Causes of Chronic Post-Surgical Spinal Pain and why another surgery is being recommended

Before we look at the latest findings on how to help patients understand their failed back surgery and what they can do about it, let’s have Ross Hauser, MD present a brief summary introduction.

In this video, Ross Hauser, MD describes the 5 main reasons that back surgery failed to help the patient’s condition.

  1. The surgery did not address the actual cause of the patient’s pain. The diagnosis is wrong.  The main cause of ‘”missed” low back pain is an injury to the Sacroiliac Joint. If your MRI showed disc degenerative disease and you had the discs operated on but the Sacroiliac Joint was not addressed, the pain will continue after the surgery.
  2. The surgery made the lower back MORE unstable. Foraminotomy, Laminectomy, Microdiscectomy, disc surgery, all have to remove parts of the bone in the spine.
  3.  The “missed secondary problem.” The surgery may have successfully addressed what was considered your primary problem, but, you really had two problems. This could be a multi-segmental problem that was not discovered until after the first surgery.
  4. Too much sitting after surgery, possibly too much bed rest.
  5. Rarer, scar tissue pinches on the nerves. This is discussed at length below.

Generally speaking, spinal pain that occurs right after surgery is from sensitized nerves, while chronic post-surgical spinal pain is often from spinal instability, but, can have many different causes. Some of these problems can include:

Now let’s get to the research:

“(Surgeons) believe that the procedure [laminectomy] is done too frequently with improper indications, and with an astounding lack of appreciation of its effect on the mechanical function of the spine.”

The above is a powerful statement. It was made forty years ago by two leading spinal surgeons Dr. Augustus  A.  White  III  and  Dr.  Manohar  M.  Panjabi, in their learning and teaching textbook Clinical Biomechanics of the Spine. In this publication, they stated simply: “We believe that the procedure [laminectomy] is done too frequently with improper indications, and with an astounding lack of appreciation of its effect on the mechanical function of the spine.”(1)

Over 40 years later, little has changed.

All spinal surgeries alter spinal mechanics, causing more force to be generated at the areas surrounding the spinal surgical site.

Laminectomy in the lower back, thoracic region, or neck can cause or lead to spinal instability. The thoracic spine is especially vulnerable to clinical instability after a laminectomy because it normally has a physiologic kyphosis (a curvature). Because of this normal curvature, the posterior ligaments are not as strong as other ligaments since the stability of the thoracic spine is partially derived from the rib cage. When the lamina (the bony plate of the vertebrae) is taken out, anterior forces prevail, making the thoracic kyphosis (curvature) and instability worse.

What type of treatment is available for failed back surgery patients? More surgery, spinal cord stimulation, epidural injection, exercise therapy, and psychotherapy . . . the evidence of the clinical outcome for each treatment has not been clearly determined.

Later in this article, we will present research and information on a few treatments that we have seen help many patients. First, we will explore the traditional options that you may already be on.

A paper in the medical journal Pain Physician (2) makes it clear that there are not many traditional remedies for the patient who is worse off after back surgery. This is from the research as it appeared in the medical journal Pain Physician.  

“Failed back surgery syndrome is a frequently encountered disease entity following lumbar spinal surgery. Although many plausible reasons have been investigated, the exact pathophysiology remains unknown.”

“Various medications, reoperations, interventions such as spinal cord stimulation, epidural adhesiolysis or epidural injection, exercise therapy, and psychotherapy have been suggested treatment options (for back pain). However, the evidence of the clinical outcome for each treatment has not been clearly determined.”

Not been clearly determined is a non-committal way to say these treatments will not meet the patient’s expectations of pain relief. They do not work. Drug addiction for many is the next step.

“Returning to the operating room is a complex and challenging decision”

April 2019 in the European Spine Journal (3) cited this research in addressing the likelihood of persistent postoperative pain following reoperation after lumbar surgery. In this paper neuro and spinal surgeons advised their fellow surgeons the following: “High rates of persistent postoperative pain (following secondary or revision spinal surgery) and associated healthcare costs suggest that returning to the operating room is a complex and challenging decision. Spinal surgeons should review whether the potential benefits of additional surgery are justified when other approaches to managing and relieving chronic pain have demonstrated superior outcomes.” (Other methods are listed below).

The problem of treatments leading to drug addiction in patients with failed back surgery syndrome

In March 2019, research led by the University of California, Berkeley published in the journal Cell Transplantation (4) offers this warning:

Failed back surgery syndrome statistics: Patients who suffer from failed back surgery syndrome are showing up in the offices and clinics of physicians, surgeons, and pain specialists in overwhelming numbers

Recently, researchers from John Hopkins University issued these concerns to their fellow spinal surgeons:(5)

Management of failed back surgery patients should, according to the John Hopkins team, begin with a systematic evaluation looking for:

Certain diagnoses may be confirmed with diagnostic procedures such as intra-articular injections, medial branch blocks, or transforaminal nerve root blocks. Once a cause is determined, a multidisciplinary approach to treatment is most effective.

The most invasive treatment option, short of revision surgery, is spinal cord stimulation. This intervention has a number of studies demonstrating its efficacy and cost-effectiveness in this population. Finally, revision surgery may be used when indicated such as with progressive neurological impairment or with issues regarding previous surgical instrumentation.

It doesn’t matter what type of spinal surgery you had, 1 in 5 people will have persistent pain after the surgery

In an April 2020 study in the Journal of Orthopaedic Surgery and Research,(6) the investigators of this study suggested that there is a substantial risk of ongoing pain following spine surgery, with 1-in-5 patients experiencing persistent postoperative pain within 2 years of surgery, the underlying indications for surgical modality and related choice of surgical procedure do not, by itself, appear to be a driving factor.

Many people we see in our office tell us that they had one surgery or another based on the level of anticipated success that the surgery would have. For many people, the surgery does provide that success, for many others not. Most notably are people who get minimally invasive spinal surgeries believing that these surgeries offer less risk. Research tells us that this is not always the case. We also address this below.

Why does spinal surgery fail to relieve pain? Why do many have “disastrous results”


There are many types of spinal surgery, each with its own success and failure rates.

Lumbar Decompression

In this article we will only touch on some of the concerns expressed by doctors with lumbar decompression, for more detailed discussion and analysis please refer to these three articles on our website:

An interesting study on cervical stenosis surgery causing lumbar stenosis complications

One example of how spinal surgery anywhere on the spine can cause problems in other areas of the spine was demonstrated by Korean and American doctors publishing in the publication Global Spine Journal. (7) They found that patients who underwent surgery for lumbar stenosis symptoms, often show radiologic evidence of cervical and thoracic spinal stenosis. However, the cervical and thoracic stenosis did not cause pain or other symptoms typical of stenosis.

When these patients were sent to lumbar decompression surgery, the prolonged surgical positioning during the lumbar decompression procedure caused the cervical and thoracic spine to become symptomatic in many patients.

This is a classic example of surgery fixing one problem and causing a worse problem in another area of the spine. Non-surgical treatments for spinal instability should be explored in these patients.

Discectomy

In a discectomy (removal of the disc), the surgeon must spread muscle and cut various ligaments in order to perform the surgery. The surgery itself can potentially lead to ligament laxity and spinal instability. Sometimes this leads to an “immediate failure,” of the back surgery.

German researchers writing in the medical journal Neurosurgical review (8) noted:

Immediate failed back surgery syndrome following lumbar microdiscectomy is defined as persistence, deterioration or recurrence (during hospital stay) of radicular pain and/or sensorimotor deficits and/or sphincter dysfunction after microdiscectomy, which was uneventful from the surgeon’s perspective.

In some patients who revealed no clear reason to have immediately failed back surgery syndrome, diagnosis of battered root syndrome (nerve root swelling due to excessive surgical manipulation) was made.

Further removal of a disc or fusion at one level can lead to disc herniation at the same level or at different levels in the future. It is very common for doctors to see a patient with “one level fixed,” while another segment of the spine is now unstable, degenerated, and causing pain as noted in the above study.

Another way surgery causes harm is that in a discectomy, a large portion of the disc remains behind. This is the portion that, if removed, will cause great risk to the patient. The remaining disc can be as much as 40% of the original disc and it can also re-herniate.

Endoscopic discectomy – the least invasive procedure – here are the patients it won’t work for

Some consider endoscopic discectomy as the least invasive surgery for disc herniation. In this procedure bones do not have to be removed, muscles do not need to be moved out of the way. In January of 2020, a paper in the Journal of Spine Surgery (9) examined independent risk factors to assess their correlation to sub-optimal outcomes after endoscopic lumbar discectomy.

Study highlights:

Results:

Non-surgical treatments for spinal instability should be explored. Please see our article on Post-laminectomy syndrome for a discussion on that topic.

What are the disastrous results in failed back surgery patients?

For patients, fixing one problem but causing the same problem to appear in another area of the spine can be seen as “disastrous results.” This is a term used by doctors in Mexico who investigated patients diagnosed with Failed Back Surgery Syndrome.

In their research they noted:

The majority of the cases in one group had a previous diagnosis of lumbar stenosis whereas disc herniation was the main diagnosis in the group number.

Therefore the disastrous results could be seen arising from “surgical error,” and MRI misinterpretation.

Research appearing in the journal, Seminars in Musculoskeletal Radiology, lists potential complications following spinal fusion which could confuse the interpretation of the MRI for doctors who are trying to see why the patient is suffering from post-surgical pain.

Radiologists are told to look for specific complications related to the use of spinal instrumentation (the hardware) that include incorrectly positioned instrumentation and failure of spinal fusion, leading to instrumentation loosening or breakage. This is in addition to leakage of cerebrospinal fluid, infection, continued disc herniation. (11)

The problem is MRI cannot tell what is causing the patient’s pain anatomically, it now has to look for suspect hardware. What if there is no suspect hardware? Diagnosis Failed Back Surgery Syndrome.

Recurrence of back or leg pain after surgery is a well-recognized problem with an incidence of up to 28%

Doctors in the United Kingdom wrote in The Journal of Bone and Joint Surgery:(12)

“Recurrence of back or leg pain after discectomy is a well-recognized problem with an incidence of up to 28%. Once conservative measures have failed, several surgical options are available and have been tried with varying degrees of success….The debate around which procedure is the most effective for these patients remains controversial.”

As mentioned above, surgery of any kind interferes can cause harm to soft tissue, revision surgery is likely not the best answer. Non-surgical treatments for spinal instability should be explored.

Not only does the MRI confuse treatment options after spinal fusion failure – It may have led directly to the failed surgery

If the MRI showed what was really causing the pain, the lumbar fusion would have worked!

Here is a remarkable finding from research on lumbar fusion success or non-success.

Writing in The Open Orthopaedics Journal,  (13) Bo Nystrom of the Clinic of Spinal Surgery in Sweden wrote:

“Results following fusion for chronic low back pain are unpredictable and generally not very satisfying. The major reason is the absence of a detailed description of the symptoms of patients with pain, if present, in a motion segment of the spine.

Various radiological findings have been attributed to discogenic pain, but if these radiological signs were really true signs of such pain, fusion would have been very successful.

If discogenic pain exists, it should be possible to select these patients from all others within the chronic low back pain population. Even if this selection were 100% perfect, however, identification of the painful segment would remain, and at present, there is no reliable test for doing so.” 

We cover this subject at length in my article MRI causes failed back surgery.

Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial.

Revision surgery is a popular treatment option. In 2007, doctors at the University of Washington published a heavily cited paper that has been referenced in more than 230 medical studies and countless articles, including this one.

The most stunning line from the study’s conclusion is this one:

“Patients should be informed that the likelihood of reoperation following a lumbar spine operation is substantial.”(14)

Most recently this research was cited in a July 2017 study from Rush University medical center doctor published in the journal Clinical Spine Surgery (15) which examined the “unfortunate” circumstance of revision lumbar surgery.

Here are the learning points of the 2017 study:

One more note on the 2007 study, in 2011 the same research team published a remarkable study in The Journal of Bone and Joint Surgery on a segment population of patients who experienced a DECLINE in revision surgeries. This is what the research said:

“The likelihood of repeat surgery for spinal stenosis declined with increasing age and comorbidity (worsen health problems), perhaps because of concern for greater risks.”(16)


Treatments

What are we seeing in this image?

It is a pelvic x-ray showing a patient’s spinal cord stimulator and the spinal fusion screws. This is a graphic display of the complication and challenges of a failed back surgery. The patient to whom this x-ray belongs had a history of multiple spinal surgeries, cortisone injections, and the implantation of a spinal cord stimulator. The patient came in to see us because she was not getting pain relief. Following Prolotherapy treatments she had the SCS removed. Her story may not be typical of patient success with treatment. It is her story.

It is a pelvic x-ray showing a patient's spinal cord stimulator and the spinal fusion screws.

In this section, we will examine various treatments. For many people these treatments may work well long-term or short-term, for others, there are limits to treatments’ successful outcomes.

There is limited evidence for oral opioids in the treatment of chronic low back pain; however, their routine use is widespread

Long-term Oxycodone – naloxone use?
Naloxone is given to counteract the long-term effects of narcotic use. In one case study, Spanish research Dr. Borja Mugabure Bujedo recorded that a combination of  Oxycodone – naloxone can be a good alternative for the management of Failed Back Surgery Syndrome when other interventional or pharmacologic strategies have failed in a case report in the journal Anesthesiology and Pain Medicine. In this case report, higher doses than those recommended as a maximum daily ceiling (80/40 mg) were used in one selected patient with severe pain. (17)

This is something the authors of the above-cited study acknowledge, “Failed Back Surgery Syndrome” obviously needs a multidimensional clinical approach. Therapy failure might result from psychosocial influences, structural abnormalities in the back, or a combination of both.”

The next sentence is much more telling. In it, Dr. Bujedo notes that despite success in this reported case history:

A 2018 study (18) published in the journal Clinical and experimental gastroenterology built on this research by suggesting that managing side-effects, in this case, constipation, would help the patient with their failed back problems. Here is what the researchers wrote: “Opioids are an effective treatment for moderate-to-severe pain. However, they are associated with a number of gastrointestinal side effects, most commonly constipation. Laxatives do not target the underlying mechanism of opioid-induced constipation, so many patients do not have their symptoms resolved. Fixed-dose prolonged-release oxycodone/naloxone tablets contain the opioid agonist oxycodone and the opioid antagonist naloxone. Naloxone blocks the action of oxycodone in the gut without compromising its analgesic effects.

Limitations of Spinal Cord Stimulators – People still take opioids

For a more comprehensive understanding of how we can help people after failed spinal cord stimulation please see our article When Spinal Cord Stimulators are not helping.

Spinal cord stimulators can be very effective for many people. We typically do not see the people from whom spinal cord stimulators were effective at our center. We see the people for whom they were not.

Spinal cord stimulation is usually reserved as a last-chance effort at controlling back pain. Specifically, it is used for people who have pain after surgery, complex regional pain syndrome, or severe nerve pain and numbness. The procedure involves implanting a small pulse generator into the stomach and running coated wires to the spine to deliver electrical impulses to the spinal cord. These electrical impulses block pain signals traveling to the brain.

In most patients we see, the spinal cord stimulator does not replace the need for narcotic medication. Additionally, a foreign device is placed in the body, which is nearly never the best option. There are risks to implanting a foreign device in the body. Some of these risks include infection, scar tissue around the stimulator, headaches, breakage of electrical wire, and pain beyond the reach of the impulses.

A February 2021 study in the Journal of Clinical Neuroscience (19) writes: “Spinal cord stimulation (SCS) has been considered as an alternative therapy to reduce opioid requirements in certain chronic pain disorders. However, information on long-term opioid consumption patterns and their impact on SCS device explanation (removed) is lacking. ”

In this study, 45 patients were followed following the removal of their spinal cord stimulation devices. Here is what happened to them:

Research shows the good and the bad 

A heavily referenced paper in The Korean Journal of Pain praised spinal cord stimulation as a widely used and efficient alternative for the management of difficult to treat chronic pain, unresponsive to conservative therapies. Technological improvements have been considerable and the current neuromodulation devices are both extremely sophisticated and reliable in obtaining good results for various clinical situations of chronic pain, such as failed back surgery syndrome, complex regional pain syndrome, ischemic and coronary artery disease. (20)

In the July 2017 issue of the medical journal Spine, doctors explained that spinal cord stimulators should be explored as the best option against further exposing patients to more failed procedures: “Clinical evidence suggests that for patients with Failed Back Surgery Syndrome), repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management. (21)

In a December 2017 study, doctors in Spain writing in the medical journal Pain Medicine acknowledge that:

  1. Spinal cord stimulation for patients with failed back surgery syndrome show variable results and limited to moderate evidence.
  2. In the last years, the stimulation of high frequency has been considered as a better alternative in this pathology for its supposed benefits compared to the stimulation with conventional frequency.

So they performed a study on 55 patients comparing the high frequency and standard frequency stimulators. The result:

The evolutionary pattern of the different parameters studied in our patients with failed back surgery syndrome does not differ according to their treatment by spinal stimulation, with conventional or high frequency, in a one-year follow-up. (22)

One did not work better than the other.

Why the spinal cord stimulations had to be removed 

Seventeen pain centers across the United States took part in a study to see why spinal cord stimulations had to be removed from patients.

In agreement with other studies, the pain centers found that clinically, spinal cord stimulation devices are cost-effective and improve function as well as the quality of life. However, despite the demonstrated benefits of spinal cord stimulation, some patients have the device removed. The researchers in this study wanted to know why.

The most common reason for device removal was:

This research appeared in the August 2017 edition of the medical journal Neuromodulation. (23)

Intrathecal drug delivery

Similar to a spinal cord stimulator, spinal drug delivery (or intrathecal drug delivery) involves implanting a small pump in the stomach and running a catheter to the spine to deliver pain medication. It is used for people with chronic back pain who need large doses of narcotics to deal with the pain. Compared to oral medication, this “pain pump” requires a smaller dose of narcotics because the medication goes directly to the area of pain.

Research in the medical journal Neuromodulation wrote of the benefits of intrathecal drug delivery. Researchers looked at patients who were averaged 67 years of age, was 68% women, and 77% were Medicare beneficiaries.

All patients taking long-acting opioids discontinued these within one month of the implant. Total systemic opioid elimination was accomplished by 68% of patients at one-month post-implant, 84% at one year, and 92% at five years. (24)

However, doctors in Germany noted in the journal Pain Physician that the assessment of the functionality of intrathecal drug delivery systems remains difficult and time-consuming. Catheter-related problems are still very common, and sometimes difficult to diagnose. (25)

Mind over body pain control

In an often referenced article, doctors at the University of Duisburg-Essen in Germany wrote in the journal BMC Complementary and Alternative Medicine:

“Mindfulness-based stress reduction (MBSR) is frequently used for pain conditions. While systematic reviews on MBSR for chronic pain have been conducted, there are no reviews for specific pain conditions. Therefore a systematic review of the effectiveness of MBSR in low back pain was performed….This review found inconclusive evidence of the effectiveness of MBSR in improving pain intensity or disability in chronic low back pain patients. However, there is limited evidence that MBSR can improve pain acceptance.”(26)

Depression after failed back surgery

In the May 2017 edition of the Journal of Physical Therapy Science, researchers concluded that the surgery experience in patients with ongoing low-back pain makes their pain and depression worse. (27)

Here are the learning points from this research:

Doctors have long been aware that many patients experience some form of post-surgical depression in the six months following an invasive procedure. However, some researchers believe that being depressed after surgery is “understandable” and “unworthy of diagnosis or treatment.”

As most people with post-surgical depression emerge from depression after about six months, many doctors consider post-surgical depression either benign or even helpful as it keeps people inactive. Nevertheless, researchers have discovered that depressed patients are more likely to have other complications following back surgery.

They are less able to cooperate in their after-care, particularly in rehabilitative therapy. For people who have an existing history of depression and anxiety, recovery from post-surgical depression is neither guaranteed nor as straightforward as some surgeons expected.

Please see a further discussion at our article Chronic back pain the impact of depression and anxiety

Prolotherapy, as will also be explained in this article, it is an injection therapy that seeks to stabilize the structures of the spine through healing soft tissue damage caused by the surgery or not fixed by the surgery. Prolotherapy is an injection technique that accelerates healing in soft tissue. Issues of hardware failure, bent or loose screws or plates, faulty wiring are issues that need to be addressed by spinal surgeons first. This article will address issues of failed back surgery syndrome where hardware failure is not the issue.

We have taken you on a journey throughout this article to show the current options that are most commonly prescribed. We are now going to continue with the discussion of Prolotherapy.

New research, new hope on avoiding revision surgery with simple tissue regeneration injections

When chronic back pain continues after back surgery, some doctors are hopeful that they can help their patients with simple sugar or dextrose Prolotherapy injections. This concept will be discussed below with appropriate medical evidence.

In research from May 2019, researchers at the Gulhane Training and Research Hospital, Traditional and Complementary Medicine Practice Center, University of Health Sciences, Ankara, Turkey wrote in the European Spine Journal : (28)

What did the researchers find?

The conclusion of this research? The doctors said:

What this research is suggesting is that if you inject a simple sugar (dextrose) into the supportive soft tissue structures of the spine, that is the spinal ligaments, tendon-bone attachments, and fascia, there is a good chance that the patient with pain following failed back surgery syndrome can get relief and a strengthen spine.

Because you have likely been suffering for some time, and because you have probably heard other researchers say the same thing about other treatments, we are going to provide you with comprehensive information on the various options you have.

Comprehensive Prolotherapy is a treatment designed to strengthen weakened soft tissue in the spine and bring stability to the area through injections, not surgery. More stability, less unnatural movement, less pain. We recommend a consultation for those on narcotics and those with spinal cord stimulators. In the case of spinal stimulators, we ask patients to bring in their X-rays showing exactly where the spinal cord stimulator is placed. As long as we can see where the stimulator electrodes are located we can safely do Prolotherapy.

Prolotherapy attacks the problems of a damaged spine instead of suppressing the symptoms. It offers a fix when all else fails. While Prolotherapy is an alternative to disc surgery, it can also help when disc surgery has already occurred yet failed to address the root issue.

The treatment begins at 1:35

When the surgery itself causes new post-surgical pain, can we treat that with Prolotherapy?

When you fuse two or three spinal segments together, mobility is lost. Spinal twisting and torque movement, however, have to come from somewhere. Where? The spinal segments above and below the fusion. These vertebral segments now have to move “excessively” to compensate. Ultimately, this extra movement and strain will cause accelerated degeneration of the disc, ligaments, and joints of these segments, thus making the person more prone to pain in these areas. This is most likely the explanation for the increased pain a few years down the road and the “need” for more operations later.

In research from Harold Wilkinson MD, published in the medical journal Pain Physician,(29), Dr. Wilkinson looked at difficult back pain cases: “Of the patients studied, 86% of patients had undergone prior lumbar spine surgery and all were referred for neurosurgical evaluation for possible surgery,” to see is simple dextrose Prolotherapy would be of benefit.

Here are some learning points:

Other Prolotherapy research (30,31,32)  has shown Prolotherapy can stabilize the areas that are painful. For most cases, three to eight visits of Prolotherapy, given once per month is all that is needed. Remember getting one spinal fusion operation may end up leading to another. Perhaps, a second opinion by a Prolotherapy doctor before getting a spinal fusion operation is needed? It may help you avoid surgery. Please refer to for more discussion Cervical pain Adjacent segment disease following neck surgery.

Platelet Rich Plasma Therapy in combination with Prolotherapy

Some doctors may recommend the use of Platelet Rich Plasma to help patients with failed back surgery syndrome. Platelet Rich Plasma is an injection of your concentrated blood platelets into the area of pain. The concentrated blood platelets bring healing and regenerating growth factors to the areas possibly damaged or affected by surgery.

Recent research says that  Platelet-rich plasma (PRP) represents an additional approach, as it has shown some promise in bone regeneration, and should be explored for its potential role in limiting spinal fusion surgery failures. (33)

In other research PRP injections into atrophied lumbar multifidus muscle were found to be a safe, effective method for relieving chronic low back pain and disability with long-term patient satisfaction and a success rate of 71.2%. (34)

In our practice, PRP is used in conjunction with dextrose Prolotherapy to stimulate healing of the ligament and tendon attachments of the spine that cause pain, muscle spasms, and degenerative disc, and other conditions.

Summary and contact us. Can we help you?

Prolotherapy can help many people who have failed back surgery by addressing spinal instability and repairing loose, lax, damaged ligaments. The key to successful treatment is identifying the right candidates. These treatments will not help everyone.

We hope you found this article informative and it helped answer many of the questions you may have surrounding your back problems and spinal instability.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

This is a picture of Ross Hauser, MD, Danielle Steilen-Matias, PA-C, Brian Hutcheson, DC. They treat people with non-surgical regenerative medicine injections.

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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This article was updated February 14, 2021

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