FAILED BACK SURGERY SYNDROME
- Persistent or recurrent low back and/or radicular pain occurs following disc surgery in 10-20% of patients.
- The outcome of any kind of treatment (including consecutive surgical intervention) is worse once surgery has taken place.
- The most common reason for reintervention is recurrent disc herniation.
- With a second intervention the rate of epidural fibrosis and instability increases to greater than 60%.
- Central low back pain with or without radicular pain.
- Pain worse in evenings than in the mornings.
- Pain may radiate into the hip and buttock areas (pseudoradicular pain or somatic referred pain).
- Pain may radiate below the knee (radicular pain).
- Pain may be worse in the sacral area mimicking sacro-iliac joint pain, especially following back fusions.
- MRI scans can be helpful when findings agree with symptoms.
- Facet nerve blocks may be helpful in diagnosing axial back pain.
- Provocation discography may be needed to diagnose discogenic pain.
- Selective nerve root blocks can help delineate painful nerve roots.
- Precision epidural blocks with fluoroscopy (transforaminal usually).
- Fluoroscopically guided caudal blocks with guidable catheter for lysis of epidural adhesions.
- Pulsed radiofrequency treatment of painful nerve roots.
- Spinal cord stimulation.
- Pain Pump implants.