If you know more than one or two people who have had back surgery, you probably know someone who has had multiple back surgeries. And you may have asked, “Why did you need to have surgery again?” You may have wondered, “If you had surgery, wasn’t your back fixed? Shouldn’t it be like new again?”
Patients needing multiple surgeries may make you think that back surgery doesn’t work, or doesn’t help. Or even that back surgery only makes things worse.
Almost every kind of surgery, or even any kind of medical intervention, comes at a cost. Back surgery is no exception. Once you have back surgery, your back will never be quite the same. So it’s important to not have back surgery unless the potential benefit is worth the cost. In other words, don’t have surgery unless you have a serious pain or problem.
That being said, spine problems can be some of the most disabling conditions. Spine problems have been shown to be more disabling than heart failure or COPD in most patients. And patients with spine disorders can score poorly on quality of life and disability tests. So, sometimes, the cost of back surgery is worth it.
So why might a patient need multiple back operations? Here are a few reasons:
- Multiple surgeries were planned from the start. Some patients have complicated problems that may be difficult or impossible to fix with a single surgery. These patients require multiple planned surgeries.
- Sometimes a smaller surgery is attempted first, but ultimately fails and so a more extensive surgery is needed later. This is not unreasonable as frequently the smaller surgery is successful and only a small subset of patients need to go back for the more extensive surgery.
- Some patients need repeat surgery to address complications. Problems like infections, hematomas, wound healing problems can happen with any surgery, including spine surgery. There are also problems more unique to spine surgery that may result in additional surgery, like recurrent disc herniations, spinal fluid leaks, or instrumentation failures. Repeat surgery is frequently required to fix these problems.
- Some patients develop new, separate problems from the original injury which required surgery. This is the most common reason patients need repeat surgery. There are 25 bones in the spine. Even if we fix the problem at one level, there are 24 other levels that can become problematic at some point. Or, you could even have novel problems at a level where you already had surgery. If a patient has a hip replaced but then later has to have the other hip replaced, you don’t assume that the original hip surgery was a failure. The patient just had a separate problem in a different location.
Even if a surgery on your spine can’t make it like new again, once a specific structural problem is identified, we can often fix that problem and relieve the resultant symptoms.
Some spine problems are serious and can lead to permanent disability, loss of function, and pain. These may require surgery right away. However, most spine surgeries are elective meaning surgery is at the discretion of the patient and the surgeon, and is based upon the expected benefits versus risks of the procedure for that specific patient.
Overall, about 25% of patients who have a back surgery will have another surgery at some point. So do what you can to minimize your risks for back surgery. Stay active. Stay fit. Use good posture and body mechanics. Have a regular exercise program. Eat a healthy well-rounded diet. Don’t smoke. Take good care of yourself so your back can take good care of you.