Failed Back Syndrome Treatment Options

Many patients with FBSS benefit from non-surgical treatment approaches before considering revision surgery. These conservative methods aim to alleviate pain, reduce inflammation, and enhance mobility.

• Physical therapy: A structured physical therapy program can help restore strength, flexibility, and posture, reducing stress on the spine. Therapists use targeted exercises, manual therapy, and modalities like ultrasound and electrical stimulation to manage pain.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and neuropathic pain medications (such as gabapentin or pregabalin) can help alleviate chronic pain. In some cases, low-dose opioids may be considered for short-term relief.
• Spinal injections: Epidural steroid injections, facet joint injections, or nerve blocks can reduce inflammation and provide temporary pain relief, allowing patients to engage in rehabilitation more effectively.
• Bracing: A lumbar or cervical brace may help stabilize the spine and reduce pain, particularly in patients with mechanical instability or poor spinal alignment.
• Psychological support and pain management programs: Chronic pain can lead to emotional distress, anxiety, and depression. Cognitive behavioral therapy (CBT) and interdisciplinary pain management programs like pain reprocessing therapy can help patients cope with the psychological impact of FBSS.

For patients who do not respond to conservative treatments, minimally invasive procedures may provide significant relief without requiring major surgery.

• Radiofrequency ablation (RFA): This procedure targets pain-causing nerves by using heat energy to disrupt their ability to transmit pain signals. RFA is often effective for patients with facet joint pain or nerve-related discomfort.
• Spinal cord stimulation (SCS): A small device implanted near the spinal cord delivers electrical impulses to disrupt pain signals before they reach the brain. SCS is a well-established option for managing chronic back and leg pain when other treatments fail.
• Intrathecal pain pumps: This treatment involves the implantation of a small pump that delivers pain-relieving medications directly into the spinal fluid. By bypassing the digestive system, lower doses of medication can be used with fewer side effects.
• Percutaneous adhesiolysis: This procedure breaks up scar tissue around nerve roots using targeted injections and catheter-based techniques. It can relieve nerve compression and improve function in some FBSS patients.

If conservative and interventional treatments do not provide relief, revision surgery may be necessary. Dr. Mathew Cyriac specializes in advanced minimally invasive and motion-preserving spinal procedures, offering patients the latest surgical techniques to optimize outcomes.

• Revision decompression surgery: In cases where residual nerve compression is present, a repeat laminectomy or foraminotomy may be needed to relieve pressure on spinal nerves.
• Spinal fusion revision: If a previous spinal fusion failed due to nonunion (failure of the bones to heal together) or hardware complications, a revision fusion with bone grafting and advanced fixation techniques may be required.
• Motion-preserving spinal procedures: Instead of fusion, some patients may benefit from total disc replacement (TDR) or other motion-preserving techniques to maintain spinal flexibility while addressing pain.
• Minimally invasive spinal surgery (MISS): Advanced techniques such as endoscopic or tubular decompression can reduce tissue trauma, minimize scarring, and lead to faster recovery compared to traditional open surgery.