Spinal fusion complication: Pelvic pain in women and the post-surgical treatment options

Our website contains many articles on the problems of undiagnosed damaged or injured spinal and pelvic ligaments causing low back and sacroiliac pain. In this article, we will discuss the problems of women who underwent spinal fusion and came home with pelvic pain.

How does a woman go in for spinal fusion surgery and come home with pelvic pain?

One answer is that the pelvic pain was there all along, it was mistaken for low back pain because an MRI gave evidence of degenerative disc disease and Sacroiliac joint dysfunction. The fact that the patients came home with pain is an indication that the surgery did not treat what was causing the pain.

The investigation into finding the true source of the woman’s low back pain – Spinal instability and pelvic instability can look exactly the same.

Spinal instability and pelvic instability are the main causes of most low back and pelvic pain. Various researchers have documented the common symptoms of clinical spinal instability and pelvic instability as:

  • including a sensation of the back ‘giving out’,
  • lower back movements are restricted by catching or locking,
  • standing or sitting in a sustained postures causes pain and spasm
  • and pain that comes and goes in varying degree of intensities.

Back surgery for pelvic pain is wrong

Dr. Bo Nystrom is a doctor whose research we often cite. In July of 2017, he led a study published in the Scandinavian Journal of Pain of the clinical outcome following anterior arthrodesis (spinal fusion) in patients with presumed sacroiliac joint pain.(1) In this study, the problems of continued or worsening pelvic pain in women treated with spinal fusion is what caught our attention.

Here are the findings of that research in 55 women.

  • Over a 6 year period, the researchers treated 55 patients, all women, with an average age of 45, the youngest being 28 the oldest 65.
  • They suffered pelvic pain for an average of about 9 years, the shortest being 2 years the longest being 30 years of pelvic pain.
  • The pain started in connection with:
    • minor trauma in seven patients,
    • pregnancy in 20 and
    • unspecified in 28.
  • All patients had undergone long periods of treatment including physiotherapy, manipulation, needling, pelvic belt, massage, and chiropractic without success, and 15 had been operated for various spinal diagnoses without improvement. (So this was their second surgical attempt to correct their low back pain.)
  • The patients underwent thorough neurological investigation, plain X-ray and MRI of the spine and plain X-ray of the pelvis. They were investigated by seven clinical tests aimed at clearly isolating indicating pain was originating from the sacroiliac joints.

At follow-up:

  • 26 patients reported a lower level of pelvic pain than before surgery,
  • 16 the same level of pelvic pain before the surgery
  • and six had a higher level of pain.
  • Again, 26 less pelvic pain, 16 same pelvic pain, 6 worse pelvic pain

A successful spinal fusion causing more pain? Where did all this pain come from? Spinal and Pelvic Ligaments

Here is the researchers’ concluding statement: “We speculate that continued pain despite a healed arthrodesis (fusion) may be due to persistent pain from adjacent ligaments. The next step should be a prospective randomized study comparing posterior fusion and ligament resection with non-surgical treatment.”

As a Prolotherapist, what more can you say? Here we had a successful spinal fusion causing more pain. Why?  Persistent pain from adjacent ligaments, we have seen it here, adjacent segment disease stressing the spinal ligaments and the surgery itself causing damage to the ligaments leading to post-spinal instability. In the research above these problems translated to pelvic pain in 45% or so women who had a spinal fusion.

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

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.  In this case our article focusesd on Pelvic Pain as being the primamtu pain geneator. Spinal fusion was performed on the wrong problem.
  2. The surgery made the lower back MORE unstable. Foraminotomy, Laminectomy, Microdiscectomy, disc surgery, all have to remove parts of bone in the spine.
  3. The “missed secondary problem.” In the context of this article this would be Pelvic instability.
  4. Too much sitting after surgery, possibly too much bed rest.
  5. More rare, scar tissue pinches on the nerves.


1 Nyström B, Gregebo B, Taube A, Almgren SO, Schillberg B, Zhu Y. Clinical outcome following anterior arthrodesis in patients with presumed sacroiliac joint pain. Scandinavian Journal of Pain. 2017 Oct 1;17:22-9.



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