Rehabilitation after spine surgery

After an incorrect preoperative diagnosis and subsequent spine surgery, probably the second most common cause of failed back surgery syndrome is improper and/or inadequate postoperative rehabilitation. As stated earlier, it often takes months to a year to heal after many of these back surgeries, and a postoperative rehabilitation program that includes stretching, strengthening and conditioning is an important part of any successful spine surgery.

In general, the bigger the back surgery, and the longer a patient has had their preoperative symptoms, the longer and harder the postoperative rehabilitation will be. It is often far more reasonable to continue with rehabilitation after spine surgery than to consider further surgery (with some exceptions, such as if there has been a recurrent disc herniation).

Secondary problems after back surgery and spine surgery
Often, there are other secondary problems that must be worked out after spine surgery.For example, a patient with a pinched L5 nerve root from a disc herniation may still need physical therapy afterward because they may have a secondary piriformis syndrome. Unpinching the L5 nerve root may relieve the radiculopathy (sciatica) but the patient still has pain in the buttocks from continued muscle spasm in the piriformis. Until this is worked out, the patient will not feel like the back surgery is successful.

Many times, spine surgery is necessary to provide enough pain relief for the patient to start a rehabilitation program, but it should only be one component of the patient’s healing process.

Unfortunately, some patients feel that if they have had back surgery they have been “fixed” and no further treatment is necessary. However, this is rarely true, and continued therapies and rehabilitation are usually necessary for a successful outcome.

After spine surgery, careful follow-up and rehabilitation is very important. If there is continued pain after back surgery, despite adequate time to heal and rehabilitation, then further workup may be warranted to find if there is a new lesion or a different type of problem that could contribute to the patient’s pain.

Failed back surgery syndrome is really not a syndrome, and there are no typical scenarios. Every patient is different, and a patient’s continued treatment and workup need to be individualized to his or her particular problem and situation.

By: Peter F. Ullrich, Jr., MD
January 28, 2003
(Updated June 1, 2004)