01 — What it is
This is a significant part of Dr. Hashmi's practice, and much of it arrives by referral from other spine surgeons. Persistent pain after an operation has identifiable causes: a level that was not addressed, a fusion that has not healed, hardware that has loosened, a segment above or below a fusion that has since degenerated, or a change in overall alignment.
Also referred to as failed back surgery syndrome.
02 — Symptoms
- Pain that did not resolve after the first operation
- A good early result, then a return of symptoms later
- New pain in a different distribution than before
- A sense of instability, or a mechanical catch with movement
03 — Causes
- Pseudarthrosis, where the fusion has not healed
- Adjacent segment degeneration above or below a prior fusion
- Residual or recurrent stenosis
- Hardware loosening, prominence or breakage
- Loss of alignment following previous surgery
04 — How it is diagnosed
Prior operative reports and previous imaging are reviewed alongside current studies. CT assesses whether a fusion has healed, which MRI cannot show reliably through metal. Standing full-length films assess balance. Diagnostic injections can help localize the source where imaging is ambiguous.
05 — Treatment approach
The first step is establishing a specific diagnosis. Where a structural cause is identified that revision surgery can address, the plan is discussed in detail, including what is likely to improve and what is not. Where the picture is not structural, that is said directly and non-surgical management is arranged instead.
General information only. Your own diagnosis and plan depend on your examination and imaging. Nothing here replaces a consultation.
