Failed Back Syndrome

The Nutritionally Healthy Spine – This continuing medical education session, presented by Lori Petrie, RD, will continue to focus on a healthy spine and the importance of nutrition in achieving and maintaining a healthy spine. This session will provide important nutritional recommendations for a healthy spine.  In addition to diet and lifestyle other factors that will be addressed for a healthy spine will include popular over-the-count medications, and a review of herbal, vitamin and nutritional supplements. Ms. Petrie is an outpatient nutritional counselor with St.Vincent Hospital.

Back Pain | Chronic and Failed – It is estimated that approximately 40% of individuals that undergo back surgery continue to have back pain.  Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group will address this ongoing issue.  In this educational session he will address both chronic back pain and failed back syndrome and will discuss the differentiation factors, and the diagnostic perils.  Additionally, Dr. Gentile will discuss the treatment options, indications and patient selection for various treatment options.  One treatment option that will be highlighted will included the spinal cord stimulator, used as an option for failed back syndrome. 

For more information about Back Talk, visit our web site, or call (317) 228-7000.

A recent blog entry discussed a spinal cord stimulator as a treatment for failed back syndrome. For additional information – here are a few links: 

• Spinal Cord Stimulators: Risks and Benefits
•  Spinal Cord Stimulators: Who is a Candidate

And here are a few links about spinal cord stimulators from the manufacturers:

• Medtronic
• Boston Scientific

When an individual continues to have chronic back pain and/or leg pain following back surgery; it is referred to as failed back syndrome. A few treatments for this can include physical therapy or non-steroidal anti-inflammatory medications (NSAID). If medical management is ineffective another treatment option available is a spinal cord stimulator.

A spinal cord stimulator is an implantable device that uses an electrical current to provide a tingling sensation that helps to mask the chronic pain. Dr. Gentile describes it as “a kind of pacemaker for pain.”

In this video, Dr. Gentile describes the procedure for implanting a spinal cord stimulator. Dr. Jonathan Gentile is a minimally invasive spine specialist with Indiana Spine Group.

This procedure is available at Indiana Spine Group. For more information, call 317.228.7000 or toll-free 866.947.7463.

Another session at Back Talk, the continuing medical education symposium for physicians and health care practitioners will address the failed back. Sometimes called failed back syndrome, failed back surgery or post-laminectomy syndrome – these patients continue to have ongoing back pain following spine surgery. 

This session will be presented by minimally invasive spine specialists Jonathan Gentile, MD, and John Arbuckle, MD, and spine surgeon Paul Kraemer, MD. With Indiana Spine Group, these physicians treat patients at our offices located on the north side of Indianapolis. 

During this continuing medical education session, the tools for physicians and health care practitioners to perform a diagnostic assessment of patients with chronic back pain following spine surgery will be highlighted. This diagnostic assessment will help caregivers to understand the underlying causes of ongoing back pain, and the mechanism of failed back. Additionally, medical and interventional treatments for failed back will be discussed – their indications and expected outcomes.

One treatment for ongoing back pain following spine surgery - sometimes referred to as failed back syndrome, is a spinal cord stimulator. A spinal cord stimulator uses electrical impulses to help relieve chronic back pain. Previous blog entries have highlighted this procedure. 

Dr. Jonathan Gentile, MD, a minimally invasive spine specialist with Indiana Spine Group, implants spinal cord stimulators - when indicated -  in patients suffering from failed back syndrome. To watch him discuss this procedure, click here. 

To learn more about how spinal cord stimulators are placed, click here – (when on the spine education page, then scroll down to "spinal cord stimulator", and click "procedure overview".  Prior to the placement of a spinal cord stimulator, the patient will go through a trial period - where the spinal cord stimulator is temporarily placed. After the trial period, if the patient feels the treatment is effective to minimize their back pain, then the implant is placed underneath the skin.

This blog entry will answer a few common questions asked about spinal cord stimulators. 

What are spinal cord stimulators used for? 

Generally spinal cord stimulators are used to treat chronic / ongoing lower back pain that continues following back / spine surgery. Back pain following spine surgery is a condition called post-laminectomy syndrome, also referred to as failed back syndrome.

When are spinal cord stimulators considered as a treatment option?

Spinal cord stimulators are a treatment option for lower back pain, when other medical management treatment options are ineffective; i.e. epidural injections and/or medications. 

What is a spinal cord stimulator?

A spinal cord stimulator is also called a neurostimulator – and this is a device that is a programmable generator that is the size of a stop watch, which has electrical leads/electrodes. The electrodes are placed in the epidural space near the spinal cord.

How does a spinal cord stimulator work?

With spinal cord stimulation electrical impulses are generated to relieve the chronic pain. The electrical impulses that are created interfere with the transmission of pain signals to the brain, and eliminate the sensation of pain that the patient would normal feel. Rather than pain, the patient feels a tingling sensation - which is called paresthesia. 

A study presented at the 23^rd annual meeting of the American Academy of Pain Medicine early last year – presented the results of the effectiveness of spinal cord stimulators to treat axial lower back pain in individuals with Failed Back Surgery Syndrome (FBSS). 

In this multi-center study, there were 226 patients from 14 different sites.  In the screening phase of the study – which was the 5- 10-day trials, 76% (176) had an average decrease in back pain of 40%.   Following this phase of the study, 159 patients received permanent spinal cord stimulator implants. 

The study concluded that there was a significant reduction of axial low back pain as a result of the spinal cord stimulator.  Preliminary data indicates that the spinal cord stimulator will effectively reduce low back pain on a long term basis, and that results should be similar to what was observed in the shorter time period.

 If you do not carry your wallet in a purse – most likely you carry it in your back pocket.  And for men, this is common place.  But did you know that your wallet can cause lower back pain?  There is even a syndrome for this called “hip pocket syndrome.” 

This spine wellness blog entry, will provide a few tips for carrying your wallet and avoiding lower back pain.

• Thin it out!  Ideally, make your wallet as thin as possible, only carrying necessary items.
• Remove it!  If you are going to be sitting for long periods of time; i.e. at work sitting at your desk, or in a car – remove your wallet from your back pocket. 

A small certain percentage of patients that undergo back surgery / spine surgery; may continue to have chronic back pain and/or lower extremity pain following surgery, that is referred to as failed back syndrome.   This is not an actual syndrome or medical diagnosis – but more a description of the symptoms.  The technical term for this is  post-laminectomy syndrome.

When medical management and other therapies are ineffective, one minimally invasive interventional pain management treatment for patients if they are suffering from both back pain and lower extremity pain is to implant a spinal cord stimulator.  A spinal cord stimulator, also called a neurostimulator uses a tiny programmable generator and electrical leads/ electrodes placed underneath the skin.  The electrodes are placed in the spinal canal, adjacent to the spinal cord.  (Photo courtesy of Medtronic, Inc.)

To learn more, read this recent press release.  This press release profiles a patient who had chronic back and lower extremity pain following back surgery.  Now she enjoys ballroom dancing!

Indiana Spine Group is a center of excellence for the treatment of spinal disorders and abnormalities.  Located in Indianapolis - with offices in Kokomo and Anderson, we provide comprehensive spine care – including interventional pain management treatments, nonsurgical spine treatments, minimally invasive spine procedures, minimally invasive spine surgery and spine surgery.  Treating both adults and children, some common diagnoses that we treat include degenerative disc disease, spinal stenosis, herniated cervical disc, failed back syndrome, osteoporosis and scoliosis. 

Physicians with Indiana Spine Group include:

§          Ken Renkens, MD (neurosurgical spine surgeon)

§           Rick Sasso, MD (spine surgeon)

§           Kevin Macadaeg, MD (minimally invasive spine specialist)

§           Thomas Reilly, MD (spine surgeon)

§          Jonathan Gentile, MD (minimally invasive spine specialist)

§          John Arbuckle, MD (minimally invasive spine specialist