Failed Back Surgery Syndrome Diagnosis & Treatments
How is Failed Back Surgery Syndrome Diagnosed?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a comprehensive diagnostic workup:
- Medical history – Assessment of symptoms, previous treatments and care.
- Physical examination – A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in the extremities, muscle weakness, loss of sensation, or signs of spinal cord damage.
- Diagnostic tests – Generally, plain x-ray films are taken which allows the physician to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine and can help detect herniated discs.
What are the Treatment Options for Failed Back Surgery Syndrome?
Treatment of failed back surgery syndrome and chronic pain is difficult. In order to accurately diagnose FBSS, a complete medical history and symptoms the patient is experiencing should be obtained. It is also important to get a current MRI or CT scan and perform diagnostic injections to better understand what is causing the pain and pinpoint the affected area.
Least Invasive Spine Procedures
- Transforaminal Endoscopic Discectomy – treats herniated, bulging, protruded, and extruded discs. Under direct visualization the physician uses the endoscope to decompress the disc to relieve the pressure on the affected spinal nerve.
- Endoscopic Foraminalplasty – treats degenerative disc, foraminal stenosis and facet disease. As the space between the facets diminishes the foramen (natural opening for the spinal and exiting nerves) becomes narrow and begins to compress the nerves. The endoscopic technique uses ronguers, reamers and small-motorized burrs to selectively take some bone in order to enlarge the foramen thus decompressing the nerves freeing them up.
- Endoscopic Rhizotomy – treats patients suffering from chronic axial back pain. When patients lean forward they are fine but leaning backwards causes significant pain and spasms. Patients who have received some temporary relief from percutaneous medial branch rhizotomy but the pain came back are good candidates for endoscopic rhizotomy. This procedure allows the physician to place a small cannula and endoscope inside the patients back and target visually the medial branch nerve. A radiofrequency probe is used through the endoscope to ablate the medial branch nerve. The results of endoscopic rhizotomy have been significantly better long-term than traditional percutaneous rhizotomy.
Minimally Invasive Spine Surgery
- Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain post-operative is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS (TLIF) – The surgery using a minimally invasive surgical approach, involves removing the damaged or degenerative intervertebral disc, and replace it with a donor bone or PEEK cage packed with donor bone to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.