Many people have successful spinal surgery. Some do not. There are many reasons why someone will have a failed spinal surgery. One reason among many can be the muscle damage caused by from surgery. Surgeons at the Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University in Japan have published a paper examining the post-surgical phenomena of back muscle degeneration in lumbar fusion patients. The goal was to find answers for failed back surgery syndrome.
The Japanese team cited research that suggested:
- up to 25% of patients report unimproved or worse pain and up to 40% are not happy with the outcome of lumbar fusion.
- While they acknowledged that there are many possible reasons for poor results, including instrumentation failure, inadequate surgical technique, and poor patient selection, they were looking for the relationship between back muscle injury after surgery.
The relationship found:
In patients who had continued pain after back surgery, muscle biposies revealed:
- atrophy of paraspinal muscles,
- loss of muscular support leading to disability and increased biomechanical strain,
- and possibly failed back syndrome .1
A team of German and Canadian researchers also found a relationship between the muscles supporting the spine adjacent to the spinal fusion segments suggesting that the paraspinal muscles of the lumbar spine play an important role in adjacent segment loading of a spinal fusion.2 If those muscles are damaged or weakened, the spine is unstable.2
Doctors at Oslo University Hospital examined patients who had continued pain 7 to 11 years after spinal fusion. The purpose was to test their observations that reduced muscle strength and density observed at one year after lumbar fusion may deteriorate more in the long term. The results: 27% reduction in muscle density.3
In earlier research from Norwegian researchers, patients with chronic low back pain who followed cognitive intervention and exercise programs improved signiﬁcantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, muscle density decreased signiﬁcantly at L3–L4 compared with the exercise group.4
Recently, more doctors have been discussing prp back pain for problems of the spine, especially when damaged spinal ligaments are causing spinal instability or enthesopathy (areas of irritable ligament attachment to bone). Among these treatments are Stem Cell Therapy, which doctors say may lead to an entire new method of treating back pain patients and Platelet Rich Plasma. Both are shown to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability and by stimulating the regeneration of the discs indirectly (while discs were not directly injected they showed an increase in disc height).5
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1 Ohtori S, Orita S, Yamauchi K, et al. Classification of Chronic Back Muscle Degeneration after Spinal Surgery and Its Relationship with Low Back Pain. Asian Spine Journal. 2016;10(3):516-521. doi:10.4184/asj.2016.10.3.516.
2 Malakoutian M, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T. Role of muscle damage on loading at the level adjacent to a lumbar spine fusion: a biomechanical analysis. Eur Spine J. 2016 Sep;25(9):2929-37. doi: 10.1007/s00586-016-4686-y. Epub 2016 Jul 27.
3 Froholdt A, Holm I, Keller A, Gunderson RB, Reikeraas O, Brox JI. No difference in long-term trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain 7 to 11 years after lumbar fusion versus cognitive intervention and exercises. Spine J. 2011 Aug;11(8):718-25. doi: 10.1016/j.spinee.2011.06.004. Epub 2011 Aug 3.
4. Keller A, Brox JI, Gunderson R, Holm I, Friis A, Reikerås O. Trunk muscle strength, cross-sectional area, and density in patients with chronic low back pain randomized to lumbar fusion or cognitive intervention and exercises. Spine (Phila Pa 1976). 2004 Jan 1;29(1):3-8.
5. Röllinghoff M, Schlüter-Brust K, Groos D, et al. Mid-range outcomes in 64 consecutive cases of multilevel fusion for degenerative diseases of the lumbar spine. Orthopedic Reviews. 2010;2(1):e3. doi:10.4081/or.2010.e3.