Why Pain Can Persist After Back Surgery—and When Spinal Cord Stimulation May Help

A failed back surgery can be extremely frustrating.

Going under the knife feels like it should be the last step in the process, a permanent long-term fix. Unfortunately, somewhere between 10-40% of these procedures fail, meaning pain persists or new symptoms emerge.

The good news is this: surgery is not the end of the line. Even when a complicated operation doesn’t provide the hoped-for relief, there are other options out there – and good ones.

Why pain can persist after back surgery

Don’t be so quick to blame the surgeon! There are real medical reasons why a back surgery may not have its desired effect. Even some surgeries that are considered a success – the original structural issue has been fixed – can result in continued pain for the patient.

Why? Pain isn’t only mechanical. It’s also neurological.

1) Nerve damage

Nerves that were compressed, inflamed, or irritated can be slow to recover following a surgical procedure. Even after decompression, they can remain sensitive, hanging on to the memory of their irritated state.

2) Scar tissue formation

Your body heals from spinal surgery by forming scar tissue. That’s the body’s natural healing process – but it can go haywire, with normal scar tissue developing around nerve roots and becoming irritants or restrictors.

3) Changed biomechanics

When one segment of the spine is altered, another may absorb additional stress. This can lead to accelerated wear and tear near the surgical site, and eventually new disc degeneration or arthritis.

4) Nervous system changes

Long periods of pain can have an altering effect on your nerves. Your spinal cord and brain can emerge from such a period more sensitive to routine signals and therefore more likely to interpret them as pain.

The step-by-step treatment pathway

Following a failed back surgery, you’ll likely be eager to aggressively attack the problem again. But it’s wiser to take things slowly, one step at a time. The best treatment pathway for a failed back surgery goes back to basics, starting with conservative treatments before re-attempting any invasive options.

Step 1: Clinical reassessment

Let’s not rush into anything! First, let’s take another look at the impacted area to get a clear picture of the current state of the spine. Patients should undergo physical examination and MRI or CT imaging, while medical professionals should do a symptom evaluation and a thorough review of the patient’s surgical history.

Step 2: Conservative care

Bouncing back from a failed back surgery is a gradual process that begins with non-invasive care. A prescription to a pain medication for temporary relief is a good early step, and rehabilitation or physical therapy is another.

Step 3: Targeted injection

If none of our conservative options are effective, it may be time to intervene further. We use injections – epidural steroid and facet joint – to determine where the pain resides and whether it’s inflammatory, joint-related, or nerve-driven. Our answers guide us toward the next stage of treatment.

Step 4: Diagnostic nerve blocks

A nerve block helps identify the specific root nerve responsible for sending pain signals. By temporarily numbing the suspect nerve and monitoring symptoms, we can zero in on our pain source, which provides us key information for our next procedure.

Step 5: Radiofrequency ablation

When a nerve block is successful in determining the pain-signaling nerve, we can apply a combination of heat and energy to the area to interrupt the transmission of these pain signals.

Step 6: Spinal cord stimulation

Patients that have not responded positively to any of the above methods may be on course for SCS, a battery-powered implant that dispenses mild electrical signals to modify pain signals on their way to the brain.

Who is a good candidate for Spinal Cord Stimulation?

By now, you feel like you’ve been through the ringer. After a lengthy painful episode that likely resulted in several failed treatment techniques, you opted for surgery. That will be the end of it, you thought.

But then, it didn’t take.

Your pain persisted so you went back to the drawing board, starting again with conservative treatments, then interventional ones.

Those didn’t work either.

So now you’re here – ready for spinal cord stimulation. If you’ve exhausted all other options and there is no clear surgical correction, it’s time to seriously consider the more permanent treatment known as SCS.

What to expect from SCS

As powerful as spinal cord stimulation is, it’s not a cure. But it is a long-term, highly effective treatment that targets your body’s pain signals from the inside using electrical currents. It acts as a remote control that turns down the volume on your pain.

After a successful trial phase that mimics the permanent implant with an external device, patients undergo an outpatient procedure to install a small battery pack under the skin. This device emits its own electrical current to replace the painful signals traveling between your spinal cord and brain.

A gradual recovery period of several weeks includes programming adjustments to the device. Pain relief often happens progressively, with normal activity participation following along.

In the weeks and months that follow SCS, patients often report decreased intensity of pain and reduced need for medication, along with less painful walking, standing, and sitting, and better sleep.

While spinal cord stimulation is a long-term therapy, upkeep is ongoing. Device setting management may continue intermittently and battery replacement is typically required after roughly five years.

How Hudson Pain and Spine can help

Folks in the Englewood, New Jersey area that have experienced a failed back surgery should contact Hudson Pain and Spine. Dr. Saurabh Dang, a double board-certified pain management specialist and an expert in failed back surgery treatment. He can help determine the best injection or care plan for you.

If your pain lasts more than two weeks, includes radiating pain, numbness, tingling, or weakness, and limits your ability to work, sleep, or do normal activities, contact Hudson Pain and Spine to schedule a consultation.

Hudson Pain and Spine 25 Rockwood Place, Suite 335, Englewood, NJ 07631 Phone: (201) 605-9000