Posts Tagged ‘degeneration’

Treating Failed Back Surgery Syndrome

Failed back surgery syndrome is the term used to describe recurring or persistent pain in the back or legs following a lumbar spine surgery.

Often, surgery is used to fix an anatomical problem, such as a herniated disc pushing on a nerve. Unfortunately, even in the hands of the most skilled surgeon, some patients will continue to have pain after the anatomical problem has been repaired. The exact number of patients who continue to suffer pain is not clear, but more surgeries appear to increase the risk of this condition.

There are many reasons why patients may continue to have pain. Low back pain is often from more than one source. For example, there could be pain from a herniated disc, or pain from arthritis in the small joints, known as facet joints. After repair of one problem, pain may persist from the other. There can be a problem related to the surgery itself, such as a complication of hardware that was inserted or an infection. Continued degeneration of the discs and joints of the spine can also cause pain. Scar tissue formation (known as epidural fibrosis) and inflammation around the nerves (known as arachnoiditis) may also cause pain.

The best treatment for FBSS is prevention. Non-operative therapy should be the first step in treating low back pain, unless there is a clear anatomical problem that requires surgical intervention. Patients should be aware that even with a skilled surgeon, there is no guarantee of complete pain resolution from a low back surgery.

If a person develops FBSS, it is important to have a multidisciplinary approach to treatment of this complex problem. If there are no problems requiring surgical intervention, then multidisciplinary care involving physical therapy, medications and spinal injections should be pursued. Physical therapy should include not only treatments for pain, such as deep heat, but also muscular training exercises and instruction on how to do daily activities to prevent increased pain. FBSS therapy may also include spinal injections, such as injections around the nerves, discs or small joints in the back or neck. Epidural steroid injections are the most common, but there are several other injections that may be helpful for treatment or facilitating diagnosis.

There are some patients that do not respond to less invasive techniques, but they may benefit from more intensive treatments, including spinal cord stimulation or pain pump implantation. Spinal cord stimulation is frequently used for the leg pain associated with FBSS. A small lead is placed in the epidural space around the spinal cord and masks pain by producing a tingling or tapping sensation in the place where pain is felt. Before having the device implanted permanently, a screening trial is performed. A temporary lead is placed where the patient feels pain and they are able to test their response to the device. Once the device is permanently implanted, the patient can turn the device on and off, as well as make some adjustments to the stimulation they receive. Another treatment is pain pump implantation, also known as intrathecal drug delivery system implantation. This pump will place medication directly into the fluid around the spinal cord, which requires a much smaller dose of medication than when taken orally. Because the medication does not circulate throughout the body and a much smaller dose is used, the frequency of side effects is less. Though morphine is the most commonly used medication in these pumps, some other opioid and non-opioid medications can be used successfully.

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Failed Back Surgery Syndrome - How to Treat It

Failed back surgery syndrome (FBSS) is a term used to describe persistent or recurring pain in the back or legs after a lumbar spine surgery. Often, surgery is used to fix an anatomical problem, such as a herniated disc pushing on a …  

Failed Back Surgery Syndrome | Better Life, Better Health through …

Well, there is actually a syndrome (which is a collection of symptoms) called “Failed Back Surgery Syndrome”. Reference Wikipedia [link here]. Apparently the failure of back surgery is so common it has generated its own clinical description . … And if you already suffer from back pain, do all of the above! And get a second, third or tenth opinion on treatment options. Try all conservative healing regimens available to you before looking at surgery….  

Causes Of Back Pain and Is Surgery Your Best Treatment

Unfortunately these surgeries, especially fusion-type, fail or have only a shelf-life of two-to-five years leading to failed back surgery syndrome for the patient. Then, why is surgery so frequently the treatment of choice? … 

Back Surgery – Back Pain Treatments 

There’s even a term for what happens when an operation doesn’t improve a patient’s condition — "failed back surgery syndrome," said to be the only diagnosis named for a treatment that hasn’t worked. It gets worse. 

Failed Back Surgery

failed back surgery syndrome (also called fbss, or failed back syndrome) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a … 


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Spondylolisthesis Treatment

In adolescents back pain may begin as the bones shift and become irritated because of their abnormal connection in the spine. Children who are active in sports and athletic activities will experience instability related to a lack of connection in the back bones that will start to be painful.

X-rays, taken at this time, may show a break in the bones; however, there are a significant number of these kids with back pain who will have normal looking x-rays. These children may need to have a further evaluation with a CT scan to help visualize the bones of the spine more specifically. Many individuals live their whole lives with a break in their vertebrae and are pain-free until their discs start to degenerate.

The largest group of patients with spondylolisthesis have degeneration in the discs that leads to back pain and doctor visits is the middle age population. As the discs degenerate, they are not able to support the weight of the spine, which allows the bones to shift. Due to the change in the position of the bones, the discs will have to bear the brunt of the patient s bodyweight and movement, which in turn, applies more stress to the discs and forces them to degenerate faster.

sciatica

The back or leg pain associated with a mild slippage of the bones will not be any more severe than the normal pain associated with age. There are no particular restrictions in activities that need to be considered in mild spondylolisthesis. As patients age the discs that are between the slipped bones will continue to degenerate. Disc cartilage degeneration can be painful and can lead to an increase in the slippage of the bones. As the spine continues to degenerate and slip, the nerves that are protected by the bones will begin to receive pressure from the discs and bones. Pinching the nerves in the back will cause pain in the distribution of the nerve roots. This pain is felt in the back of the legs and down to the foot, called sciatica. The nerve pain is usually the most painful and many patients will wonder why the doctor is checking their back when it is the leg that is hurting.

The initial treatement for the pain associated with spondylolisthesis is physcial therapy combined with anti-inflammatory medications. Exercise, stretching, traction, as well as manual therapies, can be very helpful in relieving the pain. The goal is to try to relieve the pressure on the nerve and mobilize the bones and discs to allow for a more fluid motion of the back without irritating the muscle, tendon or nerves. Most patients respond favorably to this treatment and can maintain their spines with exercise at home. If this treatment is not successful, injections of steroids around the nerves and joints may be helpful in relieving some of the acute pains. After pain reduction, the exercise program may be more effective. If all of these treatments don t work, surgery should be considered to relieve the back and leg pain. Although, most patients are reluctant to have back surgery, with the improved techniques used by the fellowship-trained orthopaedic spine surgeon, spondylolisthesis is one of the conditions of the spine that responds very successfully to surgery.

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