If your spinal fusion or discectomy only brought more pain, there is a solution… and it’s not more invasive surgery!
What if the back surgery that was supposed to relieve your pain only made it worse? What if you trusted a surgeon with your quality of life, but now, after risking invasive spinal surgery, you are hurting worse than before? Unfortunately, chronic pain is a common result of spinal surgery. It’s called Failed Back Surgery Syndrome or Post-Laminectomy Syndrome, and the terrible consequences of this condition — including chronic pain, reduced mobility and flexibility, and the risk of worsening spinal disease — are something that countless people are suffering with every day.
FBSS can lead to recurrent spinal disc herniation, persistent postoperative pressure on the spinal nerve, altered joint mobility, joint hypermobility with instability, scar tissue, depression, anxiety, and spinal muscular deconditioning.
In the past two decades, there has been a dramatic increase in spinal fusion surgery in the United States: in 2001 over 122,000 lumbar fusions were performed, a 22% increase from 1990 in fusions per 100,000 population, increasing to an estimate of 250,000 in 2003, and 500,000 in 2006. In 2003, the national cost for just the hardware used in fusion surgeries was estimated to have soared to $2.5 billion a year. And remember, a significant percentage of the patients who elect surgical treatment for back pain never heal as expected, meaning they took serious financial, physical, and emotional risks only to end up worse off than they would have been if they never had surgery in the first place.
And what often happens next only adds insult to injury… Many patients who experience new or worsening pain because of a failed back surgery return to their doctors, where they are told their only option is… another surgery.
Worse, the patients being offered this option may not even know that the odds of achieving a successful result from back surgery decrease dramatically with each attempt. While more than 50 percent find relief after a single discectomy or fusion surgery, less than one-in-three patients find relief the second time around. Unfortunately, when patients learn the odds and tell the surgeon they don’t want to go back “under the knife,” they are sometimes turned away, told that the doctor has “done all they can do.” That patient is told they have “no choice” but to live a life defined by and limited by pain.
This is wrong! As a physician helping patients in pain for over three decades, I have seen this same scenario play out too many times. These patients come to me desperate for help, but not really sure it’s possible. The surgery, which was supposed to be The Solution, failed them, and then someone told them, that’s it, there is no hope. They walk in our door emotionally exhausted, in obvious pain, convinced they will never again enjoy a decent quality of life. To be honest, that makes me angry, because I know these patients represent only a fraction of all the people who are out there suffering needlessly because of failed back surgery.
There is help out there for many people living with the symptoms of failed back surgery syndrome. I know, because I’ve helped these people find relief from pain and get back to life. With that in mind, let’s look at the symptoms associated with failed back surgery syndrome and explore proven solutions that are helping patients suffering with this condition find real, long-term relief.
What Defines Success? You might be shocked.
Failed back surgery syndrome begins with pain that hurts bad enough, often enough, and long enough for people to agree to undergo a highly-invasive, irreversible surgical procedure on one of the most sensitive parts of their body: the spine. If you have already undergone spinal surgery, or if you are seriously considering that treatment option, you know the pain all too well.
In most cases, prior to back surgery, patients are informed that “more than half of primary spinal surgeries are successful.” When you’re in that kind of pain, a more than 50-50 shot at finding relief seems reasonable. What too many of these patients do not understand is what that “shot” really means. The vertebrae of the spine are not actually “fused” during fusion surgery. The area causing the pain is “stabilized” using mechanical instruments and held in place with pins and screws. The physician conducting the surgery hopes that, over time, the vertebrae that have been stabilized will fuse together, similar to the way two pieces of a broken bone may heal. More often than not, this happens. It may not stop the pain, but the fusion does take place. However, some vertebrae never fuse, and, even when they do, the pins and screws holding them in place may become loose or damaged over time, causing new or recurrent back and leg pain.
Think about that… How would you feel if you submitted yourself to the risks associated with spinal surgery only to come out on the other side feeling worse than before! Then, you go to your doctor, and all they say is, “We can try again, but, odds are, it won’t help.”
Some people are made to believe they don’t have any other option, so they agree to go back under the knife. Please don’t take that risk without first considering other options. Because, regardless of what you may have been told, there are other options. Much better options than a surgical intervention that fails 50 to 70 percent of the time.
Better Treatment Begins With Accurate Diagnosis
Patients who have undergone one or more operations on the spine and continue to experience pain afterward can be divided into two groups:
Those for whom surgery was not actually indicated or the surgery performed were not likely to achieve the desired result.
Those for whom surgery was indicated but technically did not achieve the intended result.
Prior to treatment, it can be difficult to determine a single, primary source of the patient’s pain. There may be multiple sources and/or multiple contributing factors. Surgery that addresses one pain generator may not correct all of these factors, and, in some cases, surgery meant to address a single pain generator may even exacerbate the conditions causing pain, stiffness, and weakness in other areas of the spine. Understanding which group a patient falls into helps us determine the course of treatment most likely to achieve optimal results.
Sometimes, spinal surgery is considered a “failure,” because, even if the fusion occurs, it may result in adjacent segment degeneration, or adjacent degenerative disc disease. This is thought to occur because the fused segments may result in increased stress forces being transmitted to the discs located above and below the fused vertebrae.
Think about it this way: If you take two of the shock absorbers off of your car, the other two remaining shock absorbers will have to work harder and will wear out more quickly. In this way, the discs adjacent to a fusion are the same as the shocks on your car. They take the extra weight and stress and wear out faster than they would normally.
Another consideration is the increasing recognition of the importance of chemical radiculitis in the generation of back pain. A primary focus of surgery is to remove pressure or reduce mechanical compression on a nerve. But it is increasingly recognized that back pain, rather than being solely due to compression, may instead be due to chemical inflammation of the nerve root.
Disc herniations results in a massive inflammation of the associated nerve root. Increasing evidence has pointed to a specific inflammatory mediator of this pain. This inflammatory molecule, called tumor necrosis factor - alpha (TNF), is released not only by the herniated or protruding disc, but also in cases of disc tear (annular tear), by facet joints, and in spinal stenosis. In addition to causing pain and inflammation, TNF may contribute to disc degeneration. If the cause of the pain is not compression, but rather inflammation mediated by TNF, then this may well explain why traditional fusion surgery might not relieve the pain, and might even exacerbate it, resulting in failed back surgery syndrome.
However, this is not the only potential cause of failed back surgery syndrome. Six distinct pathologic conditions have been identified as possible causes of post-laminectomy syndrome:
Recurrent or persistent disc herniation
When one disc is removed and the adjacent vertebrae fused, this may lead to another disc herniation, either adjacent to the fused vertebrae or at another point on the spine due to increased stress and decreased shock absorption. Even the most complete surgical excision still leaves about 40 percent of the damaged disc, because this part cannot be safely removed. In addition to the discs adjacent to the fused area, the portion of the disc left in the fused joint can also re-herniate, leading to recurrent pain.
Spinal stenosis is the narrowing of the space within the spine, which may result in pressure on spinal nerves, causing pain.
Epidural scarring is a common feature when re-operating for recurrent sciatica or radiculopathy. This condition is common when the scarring is a result of recurrent stenosis or disc herniation.
This fibrous scarring within the subarachnoid space can be very difficult to detect and evaluate. Diagnosis requires an MRI with contrast.
There are many ways that damage to or pressure on nerves caused by surgery may cause pain. These include but are not limited to laceration of a nerve root, damage from cautery, chronic compression of the nerve root, or scarring. It is understood that all failed back surgery patients are experiencing some form of nerve damage.
Examination and medical imaging tests allow the physician to diagnose the most likely cause of post-surgical pain and other symptoms of failed back surgery syndrome, so the doctor can advise the treatment option most likely to help the patient. MRI tests will reveal any anatomical changes that may have occurred since surgery. These results allow us to identify one or more possible causes of the symptoms related to failed back surgery syndrome.
Treating Failed Back Syndrome Without Surgery
Successful treatments of post-laminectomy syndrome include physical therapy, minor nerve blocks, non-steroidal anti-inflammatory (NSAID) medications, membrane stabilizers, antidepressants, spinal cord stimulation, and intrathecal morphine pump. In addition, over the past decade Spinal Cord Stimulation (SCS) has become one of the most successful treatments for patients with failed back syndrome. SCS blocks or disrupts pain signals before they reach the brain, so chronic pain is replaced or eliminated. Many people have reported that their debilitating pain is dramatically reduced, allowing them to enjoy a much greater quality of life.
In addition to the proven results, one of the most popular aspects of Spinal Cord Stimulation is the opportunity for patients to “test drive” the treatment before they commit to this option long-term. Yes, you can test drive SCS and see if it’s right for you, making it a much more attractive option for many patients than another risky surgery.
Test Driving SCS
The test drive is a simple outpatient procedure that works similarly to an epidural steroid injection, but, rather than administering medicine through the needle, we place a small wire into the epidural space. We then tape the wire to the patient’s back and attach it to a very small battery that is taped to your back as well. For the next week, you go about your normal life, wearing the battery and using a remote to control the amount of pain-relieving stimulation you receive. After that time, we remove the tape, the battery, and the wire.
This test drive is a game changer for our patients, because it allows them to know how well the stimulator will work before they decide to have it permanently placed. Don’t you wish you could have taken your traditional surgery for a “test drive,” rather than having to live with chronic postoperative pain? With SCS, you have that freedom. If you wear it for a week and feel no pain relief, we take it out and look at other options. However, if spinal cord stimulation works, we discuss the long-term SCS treatment.
As with the spinal cord stimulation test drive, the permanent treatment is a simple outpatient procedure conducted at our state-of-the-art Windward Surgical Center. Two small, shallow incisions are made, the stimulator is inserted, and the patient can go home the same day, free to resume their life in a normal manner… no longer hindered by the debilitating pain of failed back syndrome.
So, if you have had back surgery and are still in pain, we would like to talk with you about one of several different cutting-edge medical treatments for failed back surgery syndrome. To learn more about these proven, non-surgical treatments, including Spinal Cord Stimulation, click here to schedule an appointment.