A retrospective study from the November 15th issue of Spine (2009) evaluated radiographs for biomechanical and other health markers that would help identify patients at risk for repeat lumbar disc herniation.
A repeat disc herniation was defined as a herniation of the same disc after a “successful” first surgery where the patient was asymptomatic for a period of at least six months. The study analysed a group of 157 disc surgery patients to determine risk factors that might help predict which patients would have a repeat herniation. Want to know what the researchers found likely to cause you or a loved one who has back surgery to need more surgery in the future. I have the anser for you below.
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More Back Surgery After the First Operation
Very similar to the co-morbidities seen with low back pain in Chiropractic practice, risk factors for repeat herniation included lifestyle factors; the most significant were smoking and obesity.
The smoking rate of recurring disc herniation patients was 71.4% and the smoking rate for patients who did not have recurring herniation was only 38.5%. Previous studies have demonstrated that smoking promotes disc degeneration and decreases circulation that is necessary to nurture the disc and facilitate healing when there is disc damage.
In addition to smoking, disc height, reduced range of motion, and disc degeneration were significant risk factors for patients with repeat lumbar disc herniation. Patients who have had previous disc surgery are common in chiropractic practice. Educating patients about these risk factors and aiding them in making the appropriate lifestyle changes can help prevent recurrent herniation and future surgery.
Spinal Surgery for Lumbar Disc Herniation
From the above article you can see that smoking was one of the biggest risk factors for re-occurring low back pain and disc height loss. So as a chiropractor I do come across patients who have a spinal disc herniation causing shoulder pain or leg sciatica pain that need to go for further intervention like spinal surgery. Thankful this is not many, but sometimes the pain and disability caused by the nerve pain needs different spinal surgery techniques to give them pain relief and return to daily life functions.
I have also come across the occasional back surgery patient where the initial sharp pain in their arm or leg has gone. However, the patient is still left with lower back ache and a pins and needles or a numb feeling in their leg or arm. This is even after having the back surgery operation.
How to Help Failed Back Surgery
In these above cases the spinal nerve that was affected by the initial lumbar disc herniation I believe became sensitised to pain and the consequence was normal nerve function became disturbed.
So for back surgery cases that still have a problem post-operation I think it is important to look to stabilise the lumbar or cervical spine through specific strengthen movements and gentle stretches.
There are also balance exercises to force the brain to create better control of movement. These are also known as proprioception exercises. A good example of balance exercising for your lower back is called “one leg stands”.
One Leg Stand Balance Exercises
- First take you shoes and socks off.
- Then stand up.
- Now stand on one leg with the other leg not touching the leg you are standing on. Feel how your foot and lower leg work hard to keep you balanced. This is with your eyes open.
- To see how well-trained your brain is try close your eyes.
Did you find it much more difficult. A goal with rehabilitation of your balance exercises is to be able to stand on one leg for at least 30 seconds both eyes open and closed. You should be able to stand without jumping all over the place and having to hang on to the chair or wall.
Some Spinal Thoughts
So once the back anatomy has been changed through surgery you would want to also try change your brain function, muscle tone and movement patterns to try decrease abnormal load on the soft tissues in your back.
Keeping a healthy back is definitely not only about trying to ‘click your spine’. You need to understand there are many body structures in between your skin and the nerve in your back. Any of these anatomical structures can be affected and cause your lower back pain.
Learning how to move your spine properly is important pre- and definitely post-operation for spinal surgery. Back rehabilitation is needed both before and after having a back surgery.
- Kim KT., Park SW., Kim YB. “Disc height and segmental motion as risk factors for recurrent lumbar disc herniation” Spine 2009 Nov 15;34(24):2674-8.