Patients who live with chronic back pain are often desperate for relief, and understandably so. Back pain can impact their ability to do basic daily tasks, such as working, driving and shopping. The pain can make it difficult to enjoy spending time with family and friends and can often lead to anxiety and depression.
It is no wonder, then, that many patients with chronic back pain seek spinal surgery as their last resort. The National Center for Biotechnology Information reports that between 1998 and 2008, the annual number of lumbar fusion surgeries performed in the United States more than doubled.
Although more than 50 percent of primary spinal surgeries are successful, for those who do not get the results they hope for and who choose additional surgeries, the odds of successful outcomes decrease significantly.[i]
Yet thanks to advances in minimally invasive interventional medicine, patients with unresolved back pain after surgery do have another option.
Failed Back Surgery Syndrome
Failed back surgery syndrome (FBSS) is also sometimes referred to as post-laminectomy syndrome. It is generally defined to be when the outcome of lumbar spinal surgery does not meet the pre-surgical expectations of the patient and surgeon.[ii]
Many FBSS patients suffer from chronic numbness, burning and/or tingling after their surgeries. Some also continue to have pain.
But interventional pain specialists can now disrupt those signals with a device known as a neurostimulator, or a spinal cord stimulator. This small device is similar to a pacemaker and is implanted just under the skin. A tiny insulated wire runs between the patient’s vertebrae and spinal cord and is connected to an external remote that the patient uses to send precise electrical pulses that interrupt pain signals before they reach the brain.
Walk, Then Run…
Patients who are candidates for spinal cord stimulation will undergo a trial, or test period, first. This involves implanting a temporary lead in their spinal space using fluoroscopic (x-ray) guidance. This lead is then connected to an external generator that enables the patient to test how well spinal cord stimulation works when they engage in physical activities. They can use the external remote to interrupt any pain signals they experience.
The patient needs to keep a detailed log of their activities, the pain that ensues and the level of pain relief that comes from utilizing the temporary device. In general, those whose pain is improved by at least 50 percent during the trial run are good candidates for a permanent SCS device.
Permanent spinal cord stimulator implantation is a minimally invasive procedure that does not require major incisions or heavy anesthesia. Although the implantation site may be tender for a day or two after the procedure, most patients return to their normal routines within 24 hours.
Many patients who thought they had expended all their options after their failed back surgery have found hope for less pain and improved quality of life through spinal cord stimulation. The International Neuromodulation Society reports that most patients experience significant pain reduction, which also has implications for other health measures, including weight control, cardiovascular health and mental well-being.[iii]
Dr. Ioannis Skaribas is fellowship trained and double board certified in anesthesiology and pain medicine. he specializes in advanced interventional pain therapies and is the only peer-to-peer educator for spinal cord stimulation in the state of Texas. He provides instruction to other physicians about the procedure on a monthly basis.