In recalcitrant cases, a Dorsal Column Stimulator may be inserted to “blank off” the pain stimuli below the brain. These have a detrimental impact on faculties, ability to work and lifestyle and are especially difficult for over-65s. These injections are usually combined with extensive medication in the form of opiates and anti-epileptic drugs. These provide short-term benefits and gradually diminishing returns Additional injections may be used to induce scarring in and around ligaments to ‘stabilise’ the spine. What are the conventional treatments?Ĭonventional treatment for failed back or neck surgery usually the form of Chronic Pain Management with repeated steroid injections into facet joints, trigger points, the spinal space and around exiting nerve roots. Unfortunately, X-rays may show impeccable surgery and scans all too often fail to show a pathology that is conventionally deemed to be significant enough to merit re-exploration. What is wrong with conventional diagnosis?Ĭonventional diagnosis is normally achieved by means of clinical findings and scans and X-rays. Minimally Invasive Spine Surgery using a laser or other high energy device can address these problems because tissue disturbance is targeted and minimised and tissue bleeding is sealed by the high energy sources such as the laser. Scarring around the nerve (Perineural Scarring) as a result of surgery, trauma or infection is difficult for conventional surgeons to treat, because the scarring is likely to recur. Where these factors do not apply or where fusion and/or total disc replacement has failed, then conventional treatment pathways will consign the patient to chronic pain management and cognitive behavioural therapy. Where a successful discectomy has been performed but over ensuing years additional degeneration in the disc(s) and facet joint(s) is deemed to be causing the patient “discogenic” pain or “instability” then this may be treated by open decompression and/or fusion.This can be treated by revision discectomy (Microdiscectomy), with or without fusion at the same time.
Where a residual or recurrent bone protrusion is deemed contributory and is safely accessible by conventional means.There are some exceptions to this, but in terms of conventional surgery the available options are somewhat limited and include the following: In reality, these terms may be used as a mask to disguise the fact that the condition is normally deemed inoperable, that ‘nothing else can be done’, and that the final resort is to refer the patient for chronic pain management. This may be referred to as a ‘multiply-operated back’. Self-evidently, failed back surgery is the outcome of surgical intervention that has been less than satisfactory in restoring a reasonable quality of life.
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