Back Surgery Improper Diagnosis

Perhaps the most common causes of failed back surgery syndrome is the poor diagnosis and selection of patients as regards the spinal pathology that is causing their back and leg pain.  Diagnostic imaging can be extremely helpful to a clinician in order to highlight a likely troublesome lesion or structure in the spine.  However, there is no guarantee that it is this particular site of spinal stenosis, disc herniation, osteophyte growth, or spinal curvature that is responsible for the patients’ symptoms.

Patients may receive a selective nerve root block, or a series of these, prior to surgery in order to isolate the particular nerve responsible for their pain.  This localized steroid injection can reduce nerve inflammation, relieve the patients’ pain, clarify which nerve is the cause of the symptoms of back pain, leg pain, numbness, weakness, and paraesthesia, and may, in some cases actually allow the nerve to heal and remove the need for back surgery.  Discography can also be useful in ascertaining the degree of disc pain at the levels above or below the site being considered for spinal surgery.  Without fully comprehending the degeneration at adjacent segments, the back surgery may simply defer the stress and symptoms to another level or carry out the procedure at the level that is not responsible for either all or part of the pain.

Some lesions in the spine are more reliable than others as predictors of back pain, with a disc herniation commonly identified as the root cause of leg pain, but not always implicated in the pathology of back pain, for example.  Accurately diagnosing piriformis syndrome as the cause of sciatica symptoms can save a patient from undergoing unnecessary back surgery.  Additionally, a patient may consider their back surgery to be a failure when, in fact, their symptoms were a combination of lumbar spinal stenosis and piriformis syndrome, for example.  In such a case, the second condition would require treatment before the back surgery may be considered successful.   Sacroiliac joint dysfunction (common amongst regular golfers) may be responsible for lower back pain and leg pain, as can a simple manganese deficiency.  Although certain misdiagnoses are unlikely, osteoarthritis or rheumatoid arthritis could be overlooked if a clinician finds initial evidence of spinal lesions and stenosis which could be the cause of back and leg pain.

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