Posted on May 21, 2023
Failed Back Surgery Syndrome (FBSS), or Post-Laminectomy Syndrome, is a condition where patients have persistent pain after spine surgery. This does not necessarily mean that the surgery was a failure, however.
In some cases, pain may be due to residual scar tissue around the nerve roots, persistent inflammation, or pain coming from an area that was not addressed by surgery.
It is estimated that the occurrence of FBSS is about 20% of back surgeries, and only about 20-30% of lumbar spine reoperations being successful.
Initial measures to treat the pain may include oral medications, physical therapy, or spinal injections. However, if pain continues despite these measures, Spinal Cord Stimulation (SCS) may be an option.
Spinal cord stimulation (SCS) involves placing neuroelectrode wires (leads) behind the spinal cord in the epidural space. These leads carry a mild electrical current which transmits to the nerve fibers of the spinal cord. This, in turn, modifies and reduces the pain signals from reaching the brain, effectively turning off the pain.
The beauty of SCS is that you can “try before you buy.” Once the leads are placed, you wear the leads for a week to see just how effective this treatment can be for you. During the one-week trial period, the leads are placed through needles, secured into placed, and then attached to the battery, which the patient carries on their side for a week.
In the trial week, if the patient receives 50% pain relief or higher from the device, it is then implanted. The leads are implanted underneath the skin in the mid-back and the battery is usually implanted in the upper buttock.
Older generations of SCS therapy involved the use of paresthesias (sensation of pins and needles) continuously in order to achieve pain relief. In addition, batteries were previously bulkier, with short longevity of battery life.
Newer generation spinal cord stimulators use sub-perception stimulation as well. Rather than relying on paresthesias (tingling) to cover the area of pain, advanced programming can now turn off the pain pathway without the patient being aware of the stimulation. This is truly the best solution.
These stimulators come in different forms, with FIXED batteries (lasting 3-7 years), RECHARGEABLE batteries, or even NO IMPLANTED BATTERIES if you are willing to use a wearable antennae attached to an external battery.
An example of success with this newer spinal cord stimulation is Nathaniel. He was a passenger in a violent auto accident in 2014, resulting in severe pain in his lower back, radiating down both legs. The pain was more intense with any activity and especially at night, interfering significantly with his sleep.
Nathaniel underwent multiple surgeries including a fusion to find a solution for the pain. But, as many patients have found, reoperation rarely leads to better outcomes.
Determined to avoid further surgery, Nathaniel sought out pain management. However, despite numerous types of injections and medications, he was only getting minimal relief. He initially tried a spinal cord stimulator in 2016, but he simply did not like the sensation of the paresthesias.
Recently, further research brought Nathaniel to Advanced Pain Management & Spine Specialists (APMSS). After his initial appointment, he immediately felt confident proceeding with implantation of this newer SCS device, which could minimize or avoid the paresthesias.
Although familiar with the procedure, Nathaniel was impressed with the team of caregivers, especially that of the staff at Park Center for Procedures. “By far, this is the best team of professionals I’ve ever encountered” he states.
A Board Certified Pain Management physician, Jonathan S. Daitch, MD explains the SCS procedure requires only 2 incisions less than 2 inches, with a quick recovery. “Within 2 weeks of my implanted SCS, I was walking around with minimal pain.” Nathaniel stated. He was able to bend, sit, lie down, and even sleep with minimal discomfort, all quite the feat after so many years of debilitating pain.
Advanced options in pain management, with proper diagnosis and appropriate treatment, can resolve or minimize pain without dependency on pain medications.
To discuss chronic pain that has “failed” treatment elsewhere, or to seek options other than surgery, call Advanced Pain Management & Specialists: 239-437-8000.