19 Oct The Best Treatment Options for Post-Fusion Pain of the Back
Fusion of the lumbar spine is a procedure in which two or more vertebrae of the lumbar spine are fused together removing the disc and cartilage present in between them and replacing it with a bone graft taken from the patient’s hip.
This surgery is generally indicated for patients that have instability, degenerative disc disease or scoliosis. The most common complication that can occur after this surgery is post-fusion back pain. This pain is largely due to a disorder known as adjacent segment disorder.
Adjacent Segment Disorder is an after effect of a spinal fusion surgery. It is different than failed back surgery syndrome. FBSS occurs when the surgery itself was unsuccessful. Adjacent segment disease with subsequent back and leg pain symptoms may take years to develop after spine surgery.
What happens is that the segments of the spinal column located near the fused vertebrae start degenerating as they begin to experience more stress due to the immobility of the fused segments. Since the fusion surgery basically stops the fused vertebrae from doing any kind of motion themselves, the vertebrae located above or below them have to compensate for their lack of movement when performing tasks like bending or twisting.
This added pressure causes these segments to wear down more rapidly than they are supposed to. Over time this degeneration can escalate and result in severe pain for the patient. This disorder mostly starts affecting a person after at least 2 to 3 years of surgery.
Orange County pain management doctors advise the following treatment options for patients who have developed symptoms of Adjacent Segment Disorder.
Non-Surgical Treatment Options
Physical therapy is seen as an excellent treatment option for treating the post-fusion back pain. These exercises are aimed at increasing the strength of the muscles present around the degenerating segments. Once these muscles become strong enough they bear the brunt of the pressure exerted on the spine and thus the patient feels free from the never ending pain.
Besides exercising and physical therapy, the use of braces and support devices is also among the non-surgical treatment options that are available to the patients of adjacent segment disorder.
The purpose of these braces is also to alleviate the extra pressure exerted on the intervertebral segments located near the fused vertebrae.
Pain relieving medicines such as NSAID’s, Tylenol and opiates are also given for containing the intensity of the pain to some patients of this disorder who do not respond well to physical therapy. Chiropractic treatment, TENS units and acupuncture may also provide exceptional relief.
Interventional Pain Treatments
For adjacent segment disease symptoms, pain management doctors in Orange County CA offer facet blocks and medial branch blocks. If the relief from those procedures wears off, then a radiofrequency ablation can provide longer term pain relief (over 12-18 months).
If the adjacent segment disease has led to spinal stenosis or pinched nerves from a herniated disc, then epidural steroid injections may provide benefit. These injections may provide relief for months at a time and then be repeated as necessary.