Indicators of failed back

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Failed back syndrome is when one has had lower back surgery, a discectomy or fusion, and still continues to live in pain. It can be referred by several names, including failed back surgery syndrome or post-laminectomy syndrome; however, what it really is is continued pain after surgery.  It is normal to have pain for several weeks, even up to a month, after lower back surgery. However, sometimes the pain will get better for a month or two, even a year, and come back again and other times the pain never goes away, or it just gets worse. In all three situations, we call failed back syndrome. 

 

Causes of Failed Back Syndrome

 

There are many possible causes for failed back syndrome including another disc herniation, a hypermobile joint with instability, or muscular deconditioning, but the vast majority of time it is caused by scar tissue. Think of scar tissue as cobwebs which attach themselves to the nerves and start causing chronic pain. 

 

Over the past 20 to 30 years, there has been a dramatic increase in spinal surgery in the United States and a percentage of these have resulted in failed back syndrome. This does not mean your surgeon did anything wrong. The vast majority of the time it is simply the scar tissue formation which will cause pain. This can be debilitating and greatly impact ones life.

 

This is not an uncommon occurrence, and there is help for you. 

Diagnosing and Treating Failed Back Syndrome

 

Treatment of failed back syndrome begins with an accurate diagnosis.  There may be multiple sources contributing to one’s pain. Treatment generally starts with an MRI, to determine the anatomic condition after surgery.  The most common cause of failed back syndrome is the amount of scar tissue produced by one’s body.  This is a normal occurrence and always happens after an incision is made.  Other rare causes of failed back syndrome, include recurrent disc herniation, spinal stenosis, postoperative adhesive arachnoiditis, and nerve injury.  This can be diagnosed with an MRI, EMG or possibly nerve conduction study.

 

Surgery is often not the best form of treatment for failed back syndrome, unless there a anatomic issue which is found in an MRI.  These treatments include nonsteroidal anti-inflammatories, antidepressants, and physical therapy.  Epidural steroid injections may also be performed but of the are not as successful. For some these will have some benefit, but for the majority of patients it will not be long lasting.  The gold standard and long-lasting treatment is spinal cord stimulation. This treatment has become the most successful for patients with failed back syndrome and works by disrupting pain signals before they reach the brain. 

 

Better minimally invasive treatments for Failed Back Syndrome

 

Spinal cord stimulation is a minimally invasive outpatient procedure that is done in two steps.  The first step which is a test drive involving two small needle sticks and you get to live for one week and see if this treatment helps with chronic pain in your daily life. If it does work, a permanent device can then be implemented, which is again a minimally invasive outpatient procedure.