Post Spine Surgery Conditions
Quick Answer: What Are Post Spine Surgery Conditions?
- They are problems that can follow spine surgery, such as adjacent segment disease, postlaminectomy syndrome, hardware failure, scar tissue (epidural fibrosis) and nerve pain that lasts or comes back.
- About 10% to 40% of people still have pain, or develop new pain, after low back surgery.
- Not every problem causes symptoms. Loose or broken hardware is sometimes found only on X-rays or CT scans.
- Ongoing or worsening symptoms after surgery should be checked by a spine specialist.
Post spine surgery conditions are a group of problems that may arise after spine procedures, including fusions, laminectomies, discectomies and other decompressions. These conditions can slow recovery, lead to lasting pain and lower long-term quality of life. This guide explains the five most common ones, how often they happen and how they are treated.
What Conditions Can Cause Pain After Spine Surgery?
- Adjacent Segment Disease (ASD)
- Postlaminectomy Syndrome (PLPS)
- Hardware Failure or Loosening
- Epidural Fibrosis (Scar Tissue)
- Persistent or New Radiculopathy
These post spine surgery conditions occur more often after certain procedures, such as posterior lumbar interbody fusion (PLIF), anterior cervical discectomy and fusion (ACDF) and multi-level decompression surgery. People having these surgeries should be told about the possible long-term risks and followed closely during recovery.
Why Does Monitoring for Post Spine Surgery Conditions Matter?
Most people improve after spine surgery, but not everyone does. About 10% to 40% of people still have pain, or develop new pain, after low back surgery [Source]. Identifying Post Spine Surgery Conditions early enables interventional options like nerve blocks, radiofrequency ablation, or even advanced techniques such as spinal cord stimulation or revision surgery.
At SpinePain Solutions, Dr. Amit Sharma takes a comprehensive, minimally invasive approach to diagnosing and treating post spine surgery conditions, with an emphasis on function, safety and long-term outcomes.
What Is Adjacent Segment Disease (ASD)?
Adjacent segment disease (ASD) is wear and tear of the spinal levels next to an earlier fusion. Studies report that ASD develops in 5% to 49% of people after lumbar fusion. The rate depends on how ASD is defined, how many levels were fused and each person’s risk factors [Source].
The risk of developing ASD is about 2% to 14% per year in the lumbar (low back) spine and about 3% per year in the cervical (neck) spine [Source]. Procedures like PLIF and ACDF are commonly linked with ASD because a fusion changes how the spine moves and carries load. Learn more on our adjacent segment disease page, or see buttock pain after lumbar fusion.
What Is Postlaminectomy Syndrome (PLPS)?
Postlaminectomy syndrome (PLPS), also known as failed back surgery syndrome (FBSS), means pain that continues after spine surgery. Estimates of how common it is range from 10% to 40%, depending on the type of surgery [Source].
More complex surgeries, such as multi-level fusions, have higher failure rates. Reported failure rates for lumbar fusion range from 30% to 46% [Source]. Nerve damage, scar tissue and spinal instability can all play a part. Read more on our postlaminectomy syndrome page.
Can Spinal Hardware Fail or Loosen?
Spinal hardware, such as rods and screws, can break or loosen over time. How often this happens depends on the type of surgery and the patient. In one study of 56 people who had neck surgery (a laminectomy and fusion with screws and rods), the hardware failed in 14 of them (25%) within about 1 to 2½ years. None of them needed another surgery during the study. Failure was much more common in people with weak bones (osteoporosis): 57% compared with 14% [Source].
Factors such as patient activity level, bone quality, and surgical technique influence the risk of hardware complications. Symptoms may include more pain or nerve problems, but hardware problems do not always cause symptoms.
What Is Epidural Fibrosis (Scar Tissue)?
Epidural fibrosis is scar tissue that forms around the nerve roots after surgery. It may lead to long-lasting pain. In one study, doctors used a thin camera to look inside the spine of 78 people who still had pain after back surgery. They found severe scar tissue in 83.3% of them [Source].
The risk of epidural fibrosis rises with the extent of the surgery and the number of levels operated on. MRI can show scar tissue, but it often misses it, which makes diagnosis hard.
Dr. Amit Sharma & our minimally invasive pain & spine team.
What Causes Persistent or New Radiculopathy?
Radiculopathy is nerve pain that spreads from the spine into the arms or legs. After surgery, it can come from a disc that herniates again (recurrent disc herniation), scar tissue or irritation of a nerve root. Studies report that 5% to 36% of people have back or leg pain again after lumbar disc surgery [Source].
Treatment starts with conservative care, such as physical therapy and medicines. Surgery is considered only when the pain does not improve. Our page on post-surgical nerve pain explains more.
When Should You See a Spine Specialist?
If you have ongoing or worsening symptoms after spine surgery, see a board-certified spine specialist who can check for post spine surgery conditions. The goal is to find the cause of the pain before choosing a treatment.
Warning Signs That Need Prompt Care
Arrange a prompt medical visit for new or worsening weakness, fever or severe pain that is not explained. Seek emergency care for new loss of bowel or bladder control, numbness around the groin or saddle area, or rapidly worsening weakness. See when back pain is an emergency.
Treatment Options for Post Spine Surgery Conditions
Care depends on the cause and how severe it is. It often starts with conservative care, such as physical therapy and medicines. Other options may include nerve blocks, radiofrequency ablation, spinal cord stimulation or revision surgery.
Post Spine Surgery Care at SpinePain Solutions
At SpinePain Solutions, Dr. Amit Sharma, Chief, Division of Pain Medicine at Good Samaritan University Hospital, offers comprehensive evaluations and personalized treatment plans for complex problems after spine surgery. We see patients at our Bay Shore, Commack and Farmingdale offices (see office locations). Call or text 631-310-0000.
Frequently Asked Questions
What is the risk of developing Adjacent Segment Disease after spinal fusion?
The risk varies based on individual factors, but studies report an annual incidence of 2–14% in the lumbar spine and about 3% in the cervical spine [Source].
How common is Postlaminectomy Syndrome?
Postlaminectomy Syndrome is also called Failed Back Surgery Syndrome. It affects about 10% to 40% of people after back surgery. The exact number is hard to pin down because doctors define it in different ways. It is more common after bigger surgeries, such as a lumbar (low back) fusion [Source].
What are the signs of hardware failure after spinal surgery?
Loose or broken spinal hardware can cause pain or nerve problems, but it does not always cause symptoms. In one study of 56 people who had neck fusion surgery with screws and rods, the hardware failed in 14 of them. None of those 14 people had symptoms, and the problems were found on follow-up X-rays or CT scans. No one in the study needed another surgery [Source].
Can scar tissue cause pain after back surgery?
Yes. Scar tissue that forms around the nerves after surgery is called epidural fibrosis, and it may play a part in ongoing pain. In one study of 78 people who still had pain after low back surgery, doctors used a thin camera placed in the spine to look for scar tissue. They found severe scarring in 83.3% of them, while MRI scans had found scar tissue in only 16.1% [Source].
What should I do if I still have pain after spine surgery?
Consult with an interventional spine specialist who can evaluate for conditions like ASD, PLPS, or scar tissue. Personalized therapies such as nerve blocks, spinal cord stimulation, or revision surgery may be recommended depending on the cause and severity.
Dr. Amit Sharma & our minimally invasive pain & spine team.
Medical References
- Ye J, Yang S, Wei Z, et al. Incidence and risk factors for adjacent segment disease after transforaminal lumbar interbody fusion in patients with lumbar degenerative diseases. Int J Gen Med. 2021;14:8185-8192. doi:10.2147/IJGM.S337298. PubMed.
- Mayfield Clinic. Adjacent segment disease: questions and answers. Mayfield Clinic.
- Orhurhu VJ, Chu R, Gill J. Failed back surgery syndrome. In: StatPearls. StatPearls Publishing; updated 2023. PMID 30969599. NCBI Bookshelf.
- American Academy of Physical Medicine and Rehabilitation. Post-laminectomy pain. PM&R KnowledgeNow. AAPM&R.
- Chen Z, Lv G, Zhang O, et al. Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF). BMC Musculoskelet Disord. 2024;25(1):1. doi:10.1186/s12891-023-07116-z. PubMed.
- Bosscher HA, Heavner JE. Incidence and severity of epidural fibrosis after back surgery: an endoscopic study. Pain Pract. 2010;10(1):18-24. doi:10.1111/j.1533-2500.2009.00311.x. PubMed.
- Tsai YH, Huang GS, Tang CT, et al. Case report: nerve root entrapment due to epidural fibrosis in a patient with failed back surgery syndrome: value of 2-(18)F-fluorodeoxyglucose simultaneous positron emission tomography-magnetic resonance imaging. Front Med (Lausanne). 2022;9:860545. doi:10.3389/fmed.2022.860545. PubMed.
