Definition
Persistent or recurrent pain after spinal surgery, also called persistent spinal pain syndrome type 2.
Aetiology
- Preoperative. Wrong diagnosis, psychosocial factors, smoking and unrealistic expectations
- Intraoperative. Wrong level, inadequate decompression, nerve injury and iatrogenic instability
- Early postoperative. Infection and epidural haematoma
- Later. Recurrent disc herniation, epidural fibrosis, adjacent segment degeneration, pseudarthrosis and arachnoiditis
Investigations
- MRI with gadolinium. Scar enhances, and recurrent disc does not enhance early
- CT for fusion, screw position and bony stenosis
- Flexion and extension radiographs for instability
- ESR and CRP when infection is suspected
Management
- Treat the cause. Revision decompression, fusion or removal of loose implants where a structural lesion is found
- Multidisciplinary pain care. Physiotherapy, cognitive behavioural therapy and graded activity
- Spinal cord stimulation. In 50 patients with persistent radicular pain, it succeeded more often than reoperation (9 of 19 versus 3 of 26)
- Success rates fall with each repeat operation
References
North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. 2005, 56(1), 98-106. PubMed
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 20 October 2026.