Persistent Post-Surgical Back and Lower Limb Pain

Many patients experience persistent lower back and lower limb pain after spinal surgery. The term “Failed Back Surgery Syndrome” is a misnomer as this ongoing pain does not necessarily indicate any deficiency with the spinal surgery. There are many potential causes for this syndrome, and there are appropriate interventions to address some of these.

For example, accelerated wear and tear on the adjacent facet joints can be amenable to radiofrequency denervation. Residual irritability of the local nerve roots can respond to epidural steroid injection or neuromodulation techniques (see Pulsed Radiofrequency Treatments and Spinal Cord Stimulation for more information). Once obvious surgical causes for persistent pain have been ruled out, specialised assessment and diagnostic techniques can be utilised to determine the way to proceed.

Clinical assessment provides some clues, however back pain symptoms and imaging findings are notoriously non-specific. This means diagnostic techniques may need to be applied in a stepwise fashion to ascertain the degree of benefit each brings the patient. Sometimes back pain is the result of pain generation for multiple sources. In this case, a procedure to relieve pain from one of the contributing sources can still be a beneficial exercise for the patient.