Failed back syndrome, or failed back surgery syndrome, is a condition in which chronic pain persists after spinal surgery. The most common reason that back surgeries fail to relieve pain is because the initial area that was operated on was not the cause of the patient's pain.

Treatment options available for patients include, but are not limited to:

  • Physical therapy
  • Anti-inflammatory medication
  • Hot and cold compressions
  • Exercise
  • Epidural steroidal injections
  • Spinal cord stimulation

To begin treating this condition, the patient's pain needs should be re-evaluated. If the surgery was performed to treat an area that was not where the pain was generated, this should be discussed between patient and doctor to consider further options and if another surgery is needed. The pain could also be caused by damage from the actual surgery. In a spinal fusion procedure, the changes made to the spine could cause new pain. So, to appropriately treat failed back syndrome, the patient should be evaluated to find out the cause of the pain so a plan can be made to manage it.

If you are still experiencing pain after a healed back surgery, this could be failed back syndrome. Contact our office to make a consultation with one of our specialists at Triangle Orthopaedics today.

Pain management:

Medical Management
Chronic Pain Management
• Expert evaluation and diagnosis
• Coordinated care
• Medical management
• Treatment planning
Electrodiagnostics (EMG/NCS)
Discogram

Common Conditions
• Joint Pain
Herniated disc
Sciatica
Spinal Stenosis
Chronic Low Back Pain
Chronic Neck Pain
Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy
Chronic Myofascial Pain
• Fibromyalgia
Failed Back Syndrome
Chronic Headache

Treatment Options
• Manual Medicine
Physical Therapy
Occupational (Hand) Therapy
Work Conditioning Programs
Cognitive/Behavioral Pain Management
Biofeedback
Hypnosis
Behavioral Therapy
• Spinal Injections
Epidural Steroid Injections

Common Non-Surgical Treatments:

Interventional Pain Management Procedures:

 

Epidural steroid injections are spine injections in the neck (cervical), mid back (thoracic spine), and low back (lumbar spine). These injections are done under x-ray guidance placing steroid (strong antiinflammatory) into the spinal canal to help with inflammation problems involving the discs and nerves of the spine. These injections can be done in the midline of the spine (interlaminar) or along side of the spine (transforaminal/selective nerve root block). These injections are mostly therapeutic (helps to treat your pain), but the selective nerve root block often times can have diagnostic use (helps to find the source of your pain).

Neck, mid back, and low back pain is often generated by the small joints of the spine (facets/zygo apophyseal joints). These can be successfully injected under x-ray guidance with steroid reducing joint inflammation and pain. These injections are quite helpful in alleviating localized neck, mid back, and low back pain. If the injection only helps temporarily, facet joint radiofrequency lesioning (RFL) is often considered.

Trigger point therapy is a temporary block of myofascial pain involving injection of local anesthetic and/or steroids. It is used in combination with therapy program to treat various muscle pain problems involving the spine and extremity. It is quite safe and can easily be performed in the office.

RFL is a procedure involving the selective blocking of pain in the neck and low back region coming from the facet joints. It involves placing a specialized needle on the small medial branch nerves that carry the pain input from the facet joints. This area is subsequently anesthetized and electricity through the needle heats the tip, burning and killing the small nerves providing pain relief 6-12 months or longer. This procedure can also be done for chronic sacroiliac joint pain.

Prolotherapy is an injection technique done to help strengthen weak tendons and ligaments. Injection is done in multiple areas stimulating new growth and strengthening the tendons and ligaments of the areas injected. It is used typically for chronic spine pain as well as chronic peripheral joint pain involving the shoulders, elbows, wrists, hips, knees, feet and ankles.

Sympathetic blocks are provided for specific nerve pain involving reflex sympathetic dystrophy/complex regional pain syndrome. These are unusual pain problems involving abnormal nerve response to injury with subsequent severe pain of the arms or legs. Sympathetic block can often times block this pain resetting the neurological system for more normal functioning and less chronic pain. Sympathetic nerve blocks are done in the neck (stellate ganglion block), and low back (lumbar sympathetic block). These are done with x-ray guidance very successfully alleviating pain from RSD/CRPS.

Spinal cord stimulator is an advanced treatment technique for refractory nerve pain involving the arm or legs with or without spine pain. A wire is implanted within the spinal canal providing stimulation on the nerves in order to block the pain input to the brain. It is often used for difficult chronic nerve pain as well as chronic back pain that has not responded to multiple surgeries. It has also been used quite successfully for pain and limitations from peripheral vascular disease.

Botox is an injection therapy into the muscle, which helps to temporarily relax the muscle. It is often used for treatment of chronic myofascial pain syndromes as well as spasticity and headache.

Percutaneous discectomy is a minimally invasive procedure in the lumbar spine for small disc herniations with radiculopathy/sciatica. It can successfully alleviate the pressure of the small disc upon the nerves without surgical intervention. It is safe and effective in the appropriate patient population.

IDET is used to treat primarily back pain coming from the disc due to torn ligaments of the disc. It is a minimally invasive procedure involved with placement of a coiled wire within the disc. This wire is then heated causing shrinkage and tightening of the disc ligaments, as well as reduction of painful nerve stimulus. This is a safe procedure for people with chronic back pain due to minimal degenerative disc disease.

A discogram is a diagnostic examination performed under x-ray guidance, in which dye is injected into the center of one or more injured discs. The doctor uses a fluoroscope (special x-ray screen) in order to see the dye in the disc(s) and assess the structural damage. During the procedure, the doctor can determine the degree of pain caused by the disc injury, as well as a diagnosis such as a ruptured, torn, or degenerated disc. Discograms are commonly performed prior to surgery in order to pinpoint the location and severity of the disc problem.

 

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