Nonsurgical Treatment for Failed Back Surgery Syndrome

If medications or physical therapy don’t alleviate the symptoms of failed back surgery syndrome, your NYU Langone orthopedist may recommend a nonsurgical treatment to help reduce pain.

Racz Catheter Procedure

When a surgery called laminectomy—the removal of a part of the vertebra, called the lamina—has led to the formation of significant scar tissue around the spinal nerves, your doctor may recommend a Racz catheter procedure, which is also called epidural neurolysis. In this procedure, the doctor injects an enzyme to soften scar tissue, which is then scraped away. This can help to reduce inflammation and pain.

Your doctor inserts a thin wire catheter above the tailbone and advances it to the scar tissue in the epidural space, the area between the membrane that surrounds the spinal nerve roots and the spinal cord—called the dura mater—and the spine. The doctor uses fluoroscopy, in which a continuous X-ray image is displayed on a monitor, to help guide the catheter to the scar tissue. He or she injects a contrast dye through the catheter to enhance the images.

Next, the doctor injects several medications, including a local anesthetic, steroids, and enzymes, through the catheter to soften scar tissue. The medications can also expand the epidural space, reducing pain in that area.

The catheter is then removed. Sometimes, it’s left in place to allow for more injections of medications in the following two to three days. It may be necessary to repeat this procedure several months later.

This procedure takes an hour and requires local anesthesia at the injection site.

Facet Joint Injections

Facet joints connect the vertebrae, providing support and stability to the spine and enabling movement. Inflammation in these joints—due to a prior surgery, osteoarthritis, or trauma, such as a car accident—can cause pain.

During facet joint injections, doctors inject local anesthesia and corticosteroids directly into the affected facet joint or joints to reduce swelling and relieve pain for days, weeks, months, or longer.

In this procedure, doctors use fluoroscopy to provide live images of the spine and joints. This allows your doctor to inject the medications precisely into the facet joint. A contrast dye may be injected into the spine to enhance the images further.

This procedure takes 15 to 30 minutes. You can return home the same day and resume your usual activities.

Radiofrequency Ablation

Your doctor may perform radiofrequency ablation to destroy nerves around the spine that carry pain impulses.

In this procedure, the doctor applies a local anesthetic to the back and inserts a needle that guides a small electronic probe toward the affected spinal nerves. Live video images of your spine help ensure the probe is properly placed in the affected area.

The probe delivers heat-generating electromagnetic waves to the affected nerves. The heat produces lesions on the nerves, destroying the tissue and eliminating pain.

This procedure takes less than an hour, and most people can return home the same day. Pain relief can be effective for some people for 12 to 36 months.

Nerve Stimulation Devices

In spinal cord nerve stimulation, electrodes are surgically implanted under the skin and over the outermost covering of the spinal cord, called the dura. Electrical stimulation can then be delivered through these electrodes using a nerve stimulation device. The stimulation can be used to manage chronic back pain.

This procedure is performed in two stages. First, trial electrodes are inserted into the back using small needles in the doctor’s office. The area may be sutured or taped. These electrodes are connected to an external battery and programmer that’s clipped onto your clothes or placed in a pocket. This device sends electrical signals to produce a painless sensation in the nerves of the back.

If the one week trial significantly reduces your pain, your doctor removes the trial electrodes and replaces them with permanent ones. These are connected to a pacemaker-like device implanted under the skin of the back.

The procedure to implant the permanent device is performed using general anesthesia and requires an overnight stay in the hospital. The battery is replaced every few years through a minor surgical procedure.

Rarely, NYU Langone neurosurgeons recommend an experimental deep brain stimulation surgery for people with severe pain caused by failed back surgery syndrome that has not been alleviated by other therapies. In this procedure, electrodes are implanted in the brain to block pain signals to the back.

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