What Is Next after a Failed Microdiscectomy?

Failed Microdiscectomy: Causes, Treatments, and Outcomes

If you have undergone microdiscectomy surgery to treat a herniated disc in your back, you may have expected to feel immediate relief from your pain. However, for some patients, the surgery does not provide the desired results, and they may continue to experience symptoms such as leg pain, numbness, tingling, or weakness. This can be very frustrating and discouraging, especially if you have invested a lot of time, money, and hope in the procedure. What can you do when a microdiscectomy fails? What are your options, and what are the possible outcomes? In this article you will learn what comes next, from understanding why the surgery might have failed to discussing alternative treatments and rehabilitation strategies.

Why Does a Microdiscectomy Fail?

A microdiscectomy is a minimally invasive surgery that involves removing a small portion of the disc material that is pressing on the spinal nerve root. The surgery has a high success rate, meaning most patients experience significant improvement or resolution of their symptoms after the operation. However, there are several reasons a microdiscectomy may fail, such as:

• Recurrent disc herniation – This is the most common cause of failed microdiscectomy. It happens when the same disc that was operated on herniates again and compresses the nerve root. This can occur soon after the surgery or years later, depending on factors such as the size and location of the initial herniation, the amount of disc material removed, the patient’s activity level, and the presence of degenerative disc disease.
• Inadequate decompression – This occurs when the surgeon does not remove enough disc material to adequately relieve the pressure on the nerve root. This can result in persistent or recurrent symptoms after the surgery.
• Scar tissue formation – This occurs when the body’s natural healing process produces scar tissue around the nerve root or the disc space. Scar tissue can cause inflammation and irritation of the nerve root, leading to chronic pain and stiffness. Scar tissue formation is more likely in patients who have had multiple surgeries or who have underlying conditions such as diabetes or smoking.
• Nerve damage – This occurs when the nerve root is injured during the surgery due to excessive traction, compression, or thermal injury from surgical instruments. Nerve damage can cause permanent or temporary loss of function or sensation.
• Other causes – There are other less common causes of failed microdiscectomy, such as infection, bleeding, spinal instability, spinal stenosis, facet joint arthritis, and sacroiliac joint dysfunction. These conditions may require additional evaluation and treatment.

What Are Your Options after a Failed Microdiscectomy?

If you have a failed microdiscectomy, you should not lose hope. There are still options available to help you manage your pain and improve your quality of life. Depending on your diagnosis, your symptoms, and your preferences, you may consider one or more of the following options:

• Conservative treatment – This involves nonsurgical methods, such as medication, physical therapy, chiropractic care, acupuncture, massage therapy, epidural steroid injections, and nerve blocks. These treatments can reduce inflammation, increase blood flow, relax muscles, and modulate pain signals. Conservative treatment may be effective for patients who have mild to moderate symptoms or who are not candidates for additional surgery.
• Revision surgery – This involves performing another surgery to correct the problem that caused the first surgery to fail. For example, if you have recurrent disc herniation, you may undergo another microdiscectomy or a more extensive discectomy to remove more disc material. If you have inadequate decompression, you may undergo a laminectomy or a foraminotomy to enlarge the space for the nerve root. If you have scar tissue formation, you may undergo a percutaneous adhesiolysis to break up the scar tissue with a needle and inject medication. Revision surgery may be effective for patients who have severe or disabling symptoms that do not respond to conservative treatment.
• Spinal fusion – This involves joining two or more vertebrae together with screws, rods, cages, or bone grafts to stabilize the spine and prevent motion at the affected segment. Spinal fusion may be necessary for patients who have spinal instability, spinal stenosis, facet joint arthritis, or sacroiliac joint dysfunction that causes chronic pain and disability. Spinal fusion may also be combined with other procedures such as discectomy or laminectomy to achieve better decompression of the nerve root.
• Artificial disc replacement – This involves replacing the damaged disc with an artificial device that mimics the function and motion of a natural disc. Artificial disc replacement may be an option for patients who have isolated disc degeneration without spinal instability or stenosis and who want to preserve their spinal mobility and flexibility.
• Regenerative medicine and stem cell therapy – Regenerative medicine, including stem cell therapy, is gaining traction as a treatment option for disc-related issues. Stem cells can promote tissue healing and potentially reduce inflammation and pain. While research is ongoing, some patients have reported positive results. 
• Lifestyle changes and rehabilitation – Regardless of the treatment path you choose, making lifestyle changes and engaging in rehabilitation are essential for long-term recovery. Maintaining a healthy weight, improving posture, and strengthening core muscles can all contribute to better spine health. Physical therapy and rehabilitation programs can provide tailored exercises and guidance to help you regain function and reduce pain.

What Are the Potential Outcomes after a Failed Microdiscectomy?

The outcomes after a failed microdiscectomy vary depending on the cause of failure, the type of treatment, and the patient’s individual factors. In general, the outcomes are better for a patient who has a clear diagnosis, a specific indication for surgery, and realistic expectations. Some of the possible outcomes are:

• Complete relief – This means the patient has no pain or other symptoms after the treatment and can resume normal activities without limitations. This is the ideal outcome, but it is not very common, especially for patients who have chronic or complex conditions.
• Partial relief – This means the patient has some improvement in pain or other symptoms after the treatment but still has some limitations or restrictions on activities. This is a more common outcome, and it may be satisfactory for some patients who can handle their residual symptoms and adapt to their lifestyle changes.
• No relief – This means the patient has no improvement or worsening of pain or other symptoms after the treatment and still has significant limitations or restrictions on activities. This is an unfavorable outcome, and it may be devastating for some patients who feel hopeless or depressed about their condition.
• Complications – These are adverse events that occur during or after the treatment that may cause additional harm or discomfort to the patient. Some of the possible complications are infection, bleeding, nerve injury, spinal cord injury, hardware failure, nonunion, pseudarthrosis, adjacent segment degeneration, and chronic pain syndrome. Complications may require further treatment or revision surgery to correct them.

A microdiscectomy is a highly effective surgery for treating pain caused by a herniated spinal disc. However, for some patients, the surgery does not work as expected, and they may continue to suffer from pain and disability. If you have a failed microdiscectomy, you should consult with your doctor to find out the cause of failure and the best treatment option for your condition. There are still ways to help you relieve your pain and improve your quality of life.

Although herniated disc treatment with microdiscectomy surgery is generally very successful, a hole is left in the outer wall of the disc. Patients with a large hole in the outer ring of the disc experience 70 percent of all reherniations after surgery. A new treatment, Barricaid, which is a bone-anchored device proven to reduce reherniations, was specifically designed to close the large hole often left in the spinal disc after discectomy. In a large-scale study, Barricaid was proven 95 percent effective in a study of over 500 patients. This means 95 percent of Barricaid patients did not undergo a reoperation due to reherniation in the 2-year study timeframe. 

If you have any questions about the Barricaid treatment or how to get access to Barricaid, ask your doctor or contact us at 844-705-1081.

For full benefit/risk information, please visit: https://www.barricaid.com/instructions.