Lower back

Failed Back Surgery

What is nerve root pain in "Failed Back Surgery"?

After an operation for a herniated (slipped) disc sometimes the pain caused by the nerve root continues to radiate down the leg even though the herniated disc is no longer pressing on the nerve root.  This is known as nerve root pain or radiculopathy.  It is also sometimes called "Failed Back Surgery Syndrome".

Cause

The herniated disc damages the nerve root so it no longer works properly. The nerve root itself then starts to produce small electrical discharges that go through the spinal cord up to the brain and cause the radiating pain in the leg.

Signs and symptoms

The main symptom of nerve root damage is pain that starts in the back and radiates down the leg. This pain is often sharp and stabbing. In addition, there may be some numbness, tingling or weakness of the muscles.

How is "Failed Back Surgery" diagnosed?

If someone has pain that radiates down the leg, it is very likely to be nerve root pain. A neurological examination includes a number of tests that can confirm this.
In addition to neurological examination, the movement of the back is examined to see if it is limited or painful. The back is also examined to see if any of the vertebrae hurt when they are pressed.

Do I need additional examinations?

  • Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires. As the neurological examination usually confirms the diagnosis, extra tests will not always be necessary because they will not affect the treatment in any way.  It is important to know that images from MRI scan have shown many people have a herniated disc even though they have no signs or symptoms. In the same way, MRI images of the back show that some people who have pain radiating down their leg and whose doctors think that they have a herniated disc, do not have a herniated disc at all.
  • For this reason, it is only useful to do an MRI scan if the diagnosis is uncertain.  An MRI scan may also show up other causes.  A CT scan is not useful as this really only shows the bones.
  • It is also possible to do an examination of the muscles (EMG) in order to find out which nerve root is causing the pain.
  • Nerve root test blocks are another way of finding out which nerve root is causing the pain in your leg.

What are my treatment possibilities?

Multidisciplinary treatment

Depending on the cause of your pain, your pain specialist will decide whether or not to start physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, apart from physical treatment, other methods of treatment will be suggested.

Non-physical treatment

If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:

Physical treatment

Medication

Interventional pain treatment