I had a disc removed from my low back about two years ago. It's been nothing but trouble since then. I thought this operation was supposed to help. What went wrong?

Patients suffering from back and/or leg pain from disc herniation may find relief with removal of the disc. But studies show this isn't always the case. Some patients get no relief from their symptoms. They may even have worse back pain. This condition is referred to as failed-back surgery syndrome.

At one time, there was concern that failure to remove the entire disc would eventually result in reherniation and a reoperation. More recent research suggests that removing as little disc material as possible is best. In fact, if at all possible, the surgeon should not enter the disc space at all. Only those disc fragments in the intervertebral (between the vertebrae) space should be removed.

There appears to be greater (not less) degeneration at the affected segmental area after disc removal. And long-term studies show that patients who have the disc removed have worse results 10 years later compared with patients who are treated nonsurgically.

It's not clear yet why failed-back surgery syndrome occurs. Studies are ongoing to find predictive factors that might help sort out which patients will be helped by disc removal. At the same time, the operative technique is being refined to give better overall results. Surgeries are becoming more and more refined with less disruption of the soft tissues and bony structures around the disc. Likewise, minimizing invasion of the disc material seems to be giving better results.