Failed back and revision surgery
When pain persists after one or more operations, the key is to tell whether there is a mechanical problem left to correct or whether the nervous system itself is sustaining the pain.
Frequently asked questionsPain that persists after surgery; now termed persistent spinal pain syndrome.
After repeated insults — herniations, stenosis, operations, scarring — the nervous system itself may generate the pain signal even though there is no longer a mechanical cause. That is why standard painkillers help little.
The first step is a complete work-up to rule out a correctable problem. If there is none, treatment combines neuromodulating drugs and, when these are not enough, spinal cord stimulation.
The name is old and misleading; that is why it is now called persistent spinal pain syndrome. It describes pain that continues after surgery, and the first task is to find out why: after repeated insults — herniations, stenosis, operations, scarring — the nervous system itself may be generating the pain signal even though there is no longer a mechanical cause.
Because it is not the same kind of pain. When the signal is sustained by the nervous system itself rather than by damage that can be corrected, standard painkillers help little. Treatment then relies on neuromodulating drugs, which act on that transmission.
It depends, and that is exactly what has to be established before touching anything. The first step is a complete work-up to rule out a correctable problem: a non-union, a misplaced implant, a degenerated neighbouring segment or a back that has lost its curve. Those can be corrected surgically. If there is none, further surgery is not the answer.
Neuromodulating drugs and, when they are not enough, spinal cord stimulation. It also has an advantage when it comes to deciding: it is implanted in two stages, with a trial period before anything permanent is placed.
The information on this page is for guidance only and does not replace a personalised medical assessment. Whether any technique is indicated depends on each patient's examination and scans.
I review your scans and tell you frankly which option makes sense, including not operating.