An Overview of Failed Back Surgery Syndrome

Most of the approximately one half million back surgeries performed annually are performed to relieve the patient from chronic pain. Of these many are successful, but many more are not, when the surgery is unsuccessful it is referred to as failed back surgery syndrome.

The reality of back surgery is that only about 25% of these surgeries are successful in relieving patients of significant pain and allowing them to return to a normal lifestyle. Of the remaining 75% most provide the patient no benefit; however some patients suffer worsening of symptoms including increased pain levels and decreased mobility, those surgeries are failed back surgery syndrome.

What are the symptoms of failed back surgery syndrome?

Symptoms of failed back surgery are often the same or worse than the symptoms of the condition that first warranted the surgery. Depending on the location of the surgery the patient will feel symptoms in different locations of the body, but they are similar symptoms and include chronic pain, numbing and tingling in extremities, decreased mobility, incontinence, decreased libido, scarring.

How is failed back surgery diagnosed?

Diagnosis of failed back surgery syndrome starts with discussing symptoms with your Chicago pain management doctor. If you have recently undergone back surgery and your symptoms were not alleviated or have worsened, your doctor will have you undergo diagnostic imaging like MRI (magnetic resonance imaging), CT scan (computerized tomography), xrays, diagnostic injections (to determine the source of pain).

What treatment is available for failed back surgery syndrome?

The treatment for failed back surgery syndrome is the same as treatment for chronic pain prior to surgery, narcotic analgesics like hydrocodone (Vicodin) and oxycodone (Percocet) are used to control chronic pain. For patients that fail to find relief from these prescription medications often the answer is nerve block injections.

What are expectations when a patient receives nerve block injections?

Most patients have a reasonable expectation for experiencing relief when they receive nerve block injections as the success rate is very high at about 90%+.

How is the nerve block injection performed?

Nerve block injections are performed on an outpatient basis. The patient is placed on an exam table, they may be sedated and have their vital signs monitored. The area to be injected is cleansed with antiseptic solution and then numbed with topical anesthetic.

A thin needle is then inserted with fluoroscope guidance; a fluoroscope is a type of xray machine that allows the doctor to see the needle being inserted in real time to ensure proper needle placement. A contrast dye is then injected to confirm the medication will contact the desired nerve.

A mixture of medications containing local anesthetics and a corticosteroid is then slowly injected, the patient often experiences immediate relief from the local anesthetic but this is temporary and generally wears off after twenty four hours. The steroid medication may take up to forty eight hours to take effect but then provides long lasting relief.

How long do the benefits of the nerve block injection last?

Relief from these injections may last for several days to several weeks depending on how well the patient responds to the medications. Generally after a series of these injections the full benefit will be realized and relief may last for several months.

What risk or side effects are possible with a nerve block injection?

Risks and side effects are minimal and include slight bruising, bleeding, and swelling at the injection site.

How successful are nerve block injections in the relief of pain?

The majority of patients, about 90%, state that they experience a significant reduction in felt pain, often as high as 90% relief, but generally between 50-70% reduction in pain is expected. Discuss your condition with your doctor to determine if you could benefit from nerve block injections.