- In general, if a patient is getting better within three months of the surgery, he or she should continue to get better.
- If there has not been any improvement in the pain approximately three months after the decompression, then the back surgery can be assumed to be unsuccessful, and further work up would be reasonable.
- During the first three months, the success of the back surgery really cannot be judged, and it is often too early to describe the procedure as either a successful or failed back surgery.
Decompression of the lumbar spine will usually relieve the patient’s leg pain directly after the back surgery. However, for 10-20% of patients, the pain will continue until the nerve starts to heal. In some cases, the pain may even be worse for a while after the back surgery because operating around the nerve root creates some increased swelling and this leads to pain.
It usually takes far longer for symptoms of numbness/tingling or weakness to resolve, and sometimes it can take up to a year for these symptoms to subside. If these symptoms persist after a year, they probably represent permanent nerve damage and are unlikely to resolve.
Recurrent Stenosis or Herniation after Decompression
Years after decompression (lumbar laminectomy), lumbar stenosis can come back (the bone can grow back) at the same level, or a new level can become stenotic and cause back pain or leg pain.
Pain that is relieved right after surgery but then returns abruptly is often due to a recurrent lumbar disc herniation. Recurrent lumbar disc herniations happen to about 5% to 10% of patients, and they are most likely to occur during the first three months after back surgery.
Technical Problems after Lumbar Decompression Surgery
Three potential technical problems that cause the pain after surgery to continue include:
- Missed fragment (of the disc or bone) is still pinching the nerve
- The back surgery operation was done at the wrong level of the spine
- Dissection of the nerve root may cause further trauma.
Nerve damage during a discectomy or a lumbar decompression is very uncommon, but has been reported in about 1 in 1,000 cases. When it does occur during back surgeries, a permanent neurological deficit with new weakness in a muscle group is possible, and a postoperative EMG (electromyography) can be helpful to see if there has been nerve damage and if there is any reinnervation (nerve healing) after the back surgery.
At times, decompressing a nerve root through back surgery will cause it to become more inflamed and lead to more pain temporarily until the inflammation subsides.
Inadequate Decompression of a Nerve Root after Surgery
Decompressing a nerve root with back surgery is not always successful, and if a portion of the nerve root is still pinched after the back surgery there can be continued pain. If this is the case, there will usually be no initial pain relief following the back surgery, and subsequent postoperative imaging studies may show continued spinal stenosis in a portion of the lumbar spine.