The treatment of postsurgical backs can be extremely difficult, especially when sciatic pains are present. This patient is still under my care and is seen bimonthly. He still has occasional soreness in his left gluteal region, but maintains that he can tolerate this. According to Calodney,1 the diagnosis and treatment of persistent pain in the previously operated low back patient is an increasingly common and complex problem. Over 300,000 laminectomies are performed in the United States each year, and as many as 10-40 percent of patients continue to experience symptoms over the long run.
Accurate diagnosis is mandatory for initiation of successful treatment.
According to a study by Burton et al.,2 the most common lesions accounting for surgical failure are recurrent or persistent disc herniation, arachnoiditis, epidural fibrosis, along with unidentified myofascial pain syndromes. In summary, I have contacted the neurosurgeons and orthopedic surgeons in the area and encouraged their referral to the chiropractor's office instead of the usual physical therapist. The chiropractor can treat the joints of the spine above and below the fusion to prevent degenerative changes. We can also do soft tissue work to alleviate myofascial problems. Surgeons understand that the failed back surgery syndrome is an iatrogenic disease.