Marc Darrow MD,JD

We receive many emails from patients who have undergone numerous spinal procedures. These people are in continued pain and are looking for help. Because of the complexities of spinal surgery, especially in patients with numerous procedures, this question must be answered following a physical examination and consultation where realistic healing options can be discussed.

When a person contacts our office looking for options to a second or even third spinal procedure we do want to help them because research has made it clear the more surgeries, the worse off the patient is.Let’s explore the research in support of that statement.

The more surgeries the worse off the patient

Some people will get benefit eventually from surgery. Some will not. Doctors, including those from the University of Bern in Switzerland published their research findings (1) on patients who had to undergo multiple spinal surgeries. When they examined patients 12 months after their last surgery they found that the more surgeries a patient had, the less likely they would have clinical success.

The Swiss doctors warned that when suggesting to patients further spinal surgeries, the patients needed to be advised that the outcome may not be good and that they, the patient, should set realistic expectations so as not to be discouraged by poor surgical outcomes.

The surgeons in this study are telling their fellow surgeons to warn their patients that the surgery will probably not help them as much as the patients may wish it would.

In a 2018 study from the Netherlands (2), surgeons recommended that doctors do not refer many patients to spinal surgery who:

  • Suffered from a degree of disability,
  • already had 2 or more previous spine surgeries,
  • psychosocial complaints, (the feeling of being unneeded, unwanted or burdensome)
  • or if the patients were over 50, because the likelihood for the majority of them is that the surgery will not be helpful.

In a recent study, doctors at Weill Cornell Medical College in New York and the Hospital for Special Surgery, discussed with patients what their pre-surgery expectations were and later after the surgery, they asked them how did it turnout?

The average age of the patient group was was 56 years old and 55% were men. Improvement in pain was the major expectation of patients undergoing lumbar spine surgery.

  • Two years after surgery 11% of patients reported no improvement in pain, (1 out of 9)
  • 28% reported a little to moderate improvement, (more than 1 out of 4)
  • In total from first two groups 40 % of the patients report no, little or moderate pain relief
  • 44% reported a lot of improvement,
  • and 17% reported complete improvement.

This same warning is echoed in a recent study in the journal Pain Practice:

The patient-physician encounter forms the cornerstone of every health service. However, optimal medical outcomes are often confounded by inadequate patient-physician communication. Therefore, it is crucial to address all components of the patient’s pain experience, including beliefs and expectations.3

Second surgeries can be risky

Recent research published in the Journal of Bone and Joint Surgery looked at the reasons and likelihood that a patient would need a second spinal surgery for stenosis. One thing that they noted was that the need for revision surgery declined but not because the first surgery was successful but because the second procedure was thought too risky.4

Emotional factors affecting poor surgery outcomes

In another new paper doctors wanted to know what emotional and physical factors would lead a back pain patient to disability:

These factors increased disability in patients:

  • female gender,
  • depression,
  • and fear avoidance beliefs as significant predictors.

What was the only factor in a patient’s life that reduced disability? Full-time employment

Understanding the relationship between these predictors and disability provides a foundation for predicting and managing disability for individual patients who suffer from low back pain. 5

When someone asks about stem cell therapy after spinal surgery, what do we answer?

For the patient suffering from back pain after numerous spinal surgeries, nothing about their life is typical except in the common question they ask, “Can stem cells really help me?”

There has to be a realistic expectation of what stem cells can do and what they can’t do. If there are issues of continued pain following a fusion surgery, stem cells may be effective in helping pain if there are issues with ligament and tendon instability causing segmental disease above and below the fusion. Stem cells may help strengthen the tendon/muscle attachments and help patients who suffer from continued spasms.

In situations where a laminectomy was performed, we would certainly explore the spinal ligaments as a possible cause of instability and pain.

In the video below is one of our back pain stem cell treatment options. Will stem cell therapy be effective in repairing damage to your spine? Please use the form below and contact me.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

1 Zehnder P, Aghayev E, Fekete TF, Haschtmann D, Pigott T, Mannion AF. Influence of previous surgery on patient-rated outcome after surgery for degenerative disorders of the lumbar spine. Eur Spine J. 2016 Aug;25(8):2553-62.
2 van Hooff ML, van Dongen JM, Coupé VM, Spruit M, Ostelo RW, de Kleuver M. Can patient-reported profiles avoid unnecessary referral to a spine surgeon? An observational study to further develop the Nijmegen Decision Tool for Chronic Low Back Pain. PloS one. 2018 Sep 19;13(9):e0203518.

2. Mancuso CA, Reid MC, Duculan R, Girardi FP. Improvement in Pain after Lumbar Spine Surgery: The Role of Preoperative Expectations of Pain Relief. Clin J Pain. 2016 Mar 28.

3. Calpin P, Imran A, Harmon D. A Comparison of Expectations of Physicians and Patients with Chronic Pain for Pain Clinic Visits. Pain Pract. 2016 Mar 15. doi: 10.1111/papr.12428. [Epub ahead of print]

4. Martin BI, Mirza SK, Comstock BA, Gray DT, Kreuter W, Deyo RA. Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine 2007 Sep 1;32(19):2119-26.

5. Melton BL, Moqbel M, Kanaan S, Sharma NK. Structural Equation Model of Disability in Low Back Pain. Spine (Phila Pa 1976). 2016 Mar 14. [Epub ahead of print]

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