Failed Back Surgery Syndrome: What Treatment Comes Next?
For many patients with severe back problems, surgery is a promising treatment option. Procedures can include removing part or all of a damaged disc, or relieving pinched nerves. However, in some cases surgery isn’t helpful and chronic pain persists. This is known as failed back surgery syndrome. This may lead to problems with further treatment, especially when you’ve resorted to surgery only when less intrusive treatments weren’t effective. There are still options for back pain relief, though.
What causes it? There are a few basic categories of failed back surgeries.
First, the surgery performed might not have originally been the best option for the particular problem.Second, the operation may have been carried out in an inadequate way. For example, the surgeon might have missed an extruding disc fragment. Nerve injuries or disc herniation can be difficult to pinpoint and detect, particularly in cases of heavy scarring. In some cases, nerves can be damaged during the surgery itself. Sometimes, though, the cause of continued pain is unclear.
Prevention: This plays an important role in back treatment strategy. One way to avoid failed back surgery syndrome is using diagnostics to be more careful about which operations are done in the first place. For example, with herniated discs, surgery is more likely to be successful when a specific pressure point has been identified. In certain patients, psychological factors can also create risks for surgical recovery.
Medication: Painkillers are often early first-line treatments for this type of problem. Methadone, typically used to help treat opioid dependence, can also be an effective painkiller and is often considered helpful in avoiding other types of strong opioids, although correct dosage can vary widely. In some cases antidepressants can be effective.
Physical therapy:Stretching and other exercise early after surgery can limit the development of scar tissue which can cause pain by binding nerve roots. Later physical therapy is sometimes helpful in freeing up nerves or otherwise increasing range of motion. Proper rehabilitation is important after any back surgery, and in some cases symptoms will eventually improve with the prescribed regimen. Back pain sometimes persists after surgery due to lack of follow-up.
Minor nerve blocks:In some cases of nerve pinching or scarring, nerve block injections may be used to help pinpoint pain sources or to relieve pain. These procedures include numbing agents and corticosteroids.
Spinal cord stimulators: Implanted electrodes, connected to a unit that can be controlled by the patient, areused as a last resort for hard to treat back pain.This stimulation is thought to help disrupt pain signals being sent to the brain. After temporary electrodes are inserted and tested to see how the patient will respond to a spinal cord stimulator, the doctor will determine the pulse strength and an amount and frequency of time that it should be used. This can relieve symptoms for patients whose surgery hasn’t helped.
Reevaluation:In most cases, further surgeries tend not to be helpful without new diagnostic information coming to light. This is especially true in patients who’ve already had multiple failed surgeries. However, new evaluation of the underlying problem causing the original back pain can improve the odds of success for any form of additional treatment.
Because these situations can be quite unique, it’s important to work closely with a back pain expert to help determine what the specific problem is and what new or existing techniques might help.