Understanding Pain
Diagnosis & Understanding
4. Neck Pain
1:55
6. Painful Diabetic Neuropathy
1:46
8. Foot Pain
1:50
9. Ankle and Foot Pain
1:46
10. Cancer Pain
1:34
Non-Surgical Treatment Options
2. Bracing
1:30
3. Acupuncture
2:13
4. Physical Therapy
1:35
5. Cognitive Behavioral Therapy
2:08
Minimally Invasive & Surgical Treatments
2. Regenerative Medicine
2:06
5. Caudal Epidural
1:33
10. Sacroiliac Joint Fusion
1:39
11. Kyphoplasty and Vertebroplasty
2:05
12. Basivertebral Nerve Ablation
1:36
13. MILD Procedure
2:04
14. Spinal Decompression Surgeries
1:41
15. Artificial Disc Replacement
1:52
Spinal Cord Stimulation (SCS)
Diagnosis & Understanding
11. Painful Diabetic Neuropathy
1:46
12. CRPS I
1:57
13. Central Sensitization Syndrome
1:48
14. Neck Pain
1:55
Non-Surgical Treatment Options
1. Physical Therapy
1:35
2. Cognitive Behavioral Therapy
2:08
3. Bracing
1:30
Minimally Invasive & Surgical Treatments
3. Stellate Ganglion Injection
1:52
4. Lumbar Sympathetic Injection
1:36
Dorsal Root Ganglion Stimulation (DRG)
Diagnosis & Understanding
3. Pelvic and Perineal Pain
1:52
7. Painful Diabetic Neuropathy
1:46
8. CRPS I
1:57
Non-Surgical Treatment Options
1. Physical Therapy
1:35
2. Cognitive Behavioral Therapy
2:08
3. Bracing
1:30
Minimally Invasive & Surgical Treatments
3. Lumbar Sympathetic Injection
1:36
Alternative & Emerging Therapies
3. Regenerative Medicine
2:06
Robert Moghim MD
Anchor Healthcare
Lumbar Fusions- Why so many with chronic pain?
1746881370
Lumbar Fusions: Why Do Many Patients Still Experience Chronic Pain?
Lumbar fusion surgery aims to stabilize the lower spine and reduce pain, but 15% to 40% of patients still have chronic pain afterward.
Why does this happen?
Incomplete nerve decompression is a major reason. If the surgery doesn't fully relieve nerve pressure, pain can persist. Scar tissue around nerves can also cause discomfort.
Adjacent segment degeneration is another issue. When part of the spine is fused, nearby sections bear more stress, leading to wear and tear, new pain, and instability.
An often overlooked cause of pain post-fusion is the sacroiliac (SI) joint. It connects the spine to the pelvis and absorbs extra stress after fusion, potentially causing dysfunction, inflammation, and pain.
Changes in spinal mechanics can strain muscles and ligaments, leading to stiffness and muscle spasms. Sometimes, the fusion may not fully heal, resulting in a condition called nonunion, causing ongoing pain.
Therefore, getting multiple opinions before deciding on surgery is crucial, as lumbar fusion is irreversible. Exploring options such as physical therapy, nerve blocks, SI joint treatments, or minimally invasive procedures can help delay or avoid surgery.
For some, reversible options like spinal cord stimulation (SCS) may offer better pain relief. SCS alters pain signals before they reach the brain and is adjustable, making it a safer alternative to permanent fusion.
Temporary or reversible pain therapies like radiofrequency ablation (RFA), peripheral nerve stimulation (PNS), and regenerative medicine offer relief without permanently altering the spine and can help avoid or delay fusion surgery.
While lumbar fusion can help some, it's not a guaranteed fix. Exploring all options, including reversible therapies and SI joint evaluation, can lead to better, long-term pain relief.
FAQs
How can the sacroiliac (SI) joint contribute to post-fusion pain?
The sacroiliac (SI) joint, which connects the spine to the pelvis, may absorb extra stress following lumbar fusion. This increased load can lead to SI joint dysfunction, inflammation, and pain, often overlooked as a source of discomfort after spinal fusion surgeries.
What are some non-surgical alternatives to lumbar fusion for pain relief?
Patients are encouraged to explore non-surgical alternatives like physical therapy, nerve blocks, and SI joint treatments. Minimally invasive procedures and reversible options like spinal cord stimulation (SCS) can offer pain relief without permanently altering the spine structure.
What other factors can cause pain after lumbar fusion surgery?
Apart from nerve and joint issues, changes in spinal mechanics after a fusion can strain muscles and ligaments, resulting in stiffness and muscle spasms. Moreover, if the fusion does not fully heal, a condition known as nonunion can develop, causing persistent pain.
Why do some patients still experience chronic pain after lumbar fusion surgery?
Chronic pain after lumbar fusion can occur due to incomplete nerve decompression, where the surgery fails to fully alleviate nerve pressure. Scar tissue around nerves can also contribute to ongoing discomfort. Additionally, adjacent segment degeneration, resulting from the increased stress on nearby spinal segments post-fusion, can lead to new pain and instability.
Why is it important to get multiple opinions before undergoing lumbar fusion surgery?
Lumbar fusion is an irreversible procedure, so obtaining multiple medical opinions ensures that all factors contributing to pain are considered. Exploring all possible options, such as reversible therapies and SI joint evaluations, may provide more effective, long-term pain management without immediate reliance on surgery.