Coastal Orthopedic Pain & Spine Center
CONDITION
FAILED BACK SURGERY SYNDROME
This refers to patients who experience persistent pain after spine surgery that did not provide successful results. Incorrect or incomplete diagnoses can result in surgery that fails to address the underlying cause of the pain. Continued pain after surgery can stem from various factors, such as nerve damage, insufficient nerve decompression, infection, or the accumulation of scar tissue. Patients may also experience symptoms like weakness, joint instability, numbness, or throbbing and aching in the area of the surgery.
Learn more about Failed Back Surgery Syndrome and treatment at Coastal Orthopedic Pain & Spine Center, call us at 727-526-8000 to schedule an appointment.
TREATMENT
TRIGGER POINT CORTISONE INJECTIONS
Trigger point injections (TPIs) involve injecting cortisone directly into specific trigger points in the body to alleviate inflammation and muscle spasms that contribute to pain and discomfort. In some cases, a failed back surgery can lead to muscle tension, which can worsen the pain. Trigger point injections help relax these tense muscles, providing relief from the pain and discomfort associated with muscle tightness.
TREATMENT
MEDICATION MANAGEMENT
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
NSAIDs are over-the-counter medications that help relieve back pain by reducing inflammation in the nerve roots and spinal joints. Common NSAIDs include ibuprofen, naproxen, and aspirin. While these medications can be effective for initially managing back pain, if they do not provide sufficient relief, your doctor may prescribe stronger medications to help control your pain.
MUSCLE RELAXANTS
Muscle relaxants help ease muscle tension by reducing the activity of the central nervous system. After back surgery, muscle spasms may occur due to muscle bruising, movement, or cutting, which can lead to pain and discomfort. Common muscle relaxants are cyclobenzaprine, methocarbamol, and baclofen.
NEUROPATHIC AGENTS
Gabapentin and pregabalin are the most commonly prescribed neuropathic agents for failed back surgery syndrome (FBSS). These antiepileptic drugs are effective in managing the neuropathic pain associated with the condition. Depending on the severity and specific case, other neuroleptic medications may also be considered as treatment options.
PAIN RELIEVERS
In some cases of severe pain, the doctor may prescribe opioids in conjunction with other treatment options in order to alleviate symptoms. In these cases a multi-modal approach is used to limit tolerance and dependence.
TREATMENT
EPIDURAL INJECTIONS
Epidural steroid injections (ESI) involve injecting a small dose of corticosteroid into the epidural space in the spine, which is the area between the vertebrae and the dural sac surrounding the spinal cord. The purpose of the injection is to reduce inflammation around the nerve roots, which can help alleviate pain in the neck, back, and limbs. The effectiveness of ESIs varies from person to person, with relief typically lasting from weeks to months. If pain returns, additional injections may be considered for continued relief.
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The procedure is performed while the patient is awake and lying on their stomach. The area of injection (back or neck) is cleaned with antiseptic, and a local anesthetic is applied to numb the skin. Using fluoroscopic (X-ray) guidance, the doctor inserts a needle into the epidural space to administer the steroid. The procedure is generally quick, with pressure felt during the needle insertion. Afterward, the skin is cleansed and a bandage is applied. The bandage can be removed the next day.
TREATMENT
MEDIAL BRANCH BLOCKS & RADIOFREQUENCY ABLATION
​​A facet block or medial branch block may be therapeutic and/or diagnostic. One of three things may happen:
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The pain does not go away, which means that the pain is probably not coming from the blocked facet joints. This has diagnostic value.
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The pain goes away and stays away for a few hours, but the original pain comes back and doesn't get better again. This would mean the block was also of diagnostic value, indicating that the pain is probably coming from the joints but the steroid was not of benefit.
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The pain goes away after the block, may come back later that day, but then gets better again over the next few days. This means that the block was of therapeutic value because the steroid had a long lasting effect on the pain.
If you get a positive, lasting benefit from the injections, the block may be repeated. If you get a positive, short-term benefit, another procedure called radiofrequency ablation may be done which may last months to years.
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Radiofrequency ablation (RFA) uses radio waves to create a current that heats a small area of nerve tissue. The heat destroys that area of the nerve, stopping it from sending pain signals to your brain. RFA can provide lasting relief for people with chronic pain, especially in the lower back, neck, and arthritic joints.
TREATMENT
SACROILIAC JOINT INJECTIONS
Sacroiliac joint dysfunction is often an overlooked cause of chronic low back pain, sacroiliac joint injections under fluoroscopy can be considered for persistent low back pain following Failed Back Surgery Syndrome. Performed under fluoroscopic gudiance to precisely deliver medication into the joint, these injections can be effective at reducing pain and improving mobility.
TREATMENT
SPINAL CORD STIMULATOR
Spinal cord stimulation is a procedure where a small device, known as a spinal cord stimulator, is implanted in the spine. Once in place, the stimulator sends electrical impulses that help to block or mask the patient's pain. Using a remote control, patients can activate the device to deliver these impulses to their spine, providing pain relief.​
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Spinal cord stimulation (SCS) is a therapy often used to treat failed back surgery syndrome (FBSS). A trial period is utilized to ensure it provides relief prior to the consideration of an implant.