Treatment After Failed Spine Surgery | Austin, TX

Failed Back Surgery Syndrome

When back surgery hasn't provided the relief you hoped for — advanced interventional options to restore quality of life.

Overview

Failed back surgery syndrome (FBSS) refers to chronic back or leg pain that persists or recurs after lumbar spine surgery — including discectomy, laminectomy, spinal fusion, or other procedures. It is estimated to affect 10–40% of patients who undergo lumbar spine surgery and represents one of the most challenging and underserved populations in pain medicine. Despite its name, FBSS does not imply any error in surgical technique; rather, it reflects the complexity of spinal pain and the limitations of surgery as a pain treatment. Dr. Migdale specializes in the interventional management of FBSS, where her dual training in neuromodulation and musculoskeletal medicine is particularly valuable.

Why Does Pain Persist After Back Surgery?

Back surgery can fail to relieve pain for multiple reasons: the surgery may have addressed the structural problem but the nervous system had already become sensitized (central sensitization); scar tissue (epidural fibrosis) can form around nerve roots after surgery; adjacent disc levels may develop new pathology following fusion; and in some cases, the original pain generator may not have been correctly identified before surgery.

Why Spinal Cord Stimulation Is the Gold Standard for FBSS

Multiple high-quality clinical trials have demonstrated that spinal cord stimulation outperforms repeat surgery and continued opioid therapy for FBSS. SCS works by delivering mild electrical pulses to the spinal cord that modulate pain signals before they reach the brain. Modern SCS systems offer advanced waveforms — including high-frequency and burst stimulation — that provide effective relief without the paresthesia (tingling sensation) of older systems.

Other Options

Beyond SCS, Dr. Migdale evaluates FBSS patients for other contributing factors that may be amenable to targeted treatment: facet joint pain (medial branch blocks, radiofrequency ablation); epidural adhesions (epidural lysis of adhesions, where appropriate); sacroiliac joint dysfunction; myofascial components (trigger point injections, manual therapy); and medication optimization. A thorough evaluation is essential before recommending any specific intervention.

Common Questions

Frequently Asked Questions

Is it worth seeing a pain physician after back surgery?
Absolutely — particularly if your pain persists or has returned. An interventional pain physician can evaluate the specific causes of your ongoing pain, rule out new structural problems, and offer a range of non-surgical treatments including neuromodulation. Many FBSS patients who had given up hope of improvement experience meaningful relief with the right interventional approach.
What is spinal cord stimulation and is it right for me?
Spinal cord stimulation (SCS) is an implanted device that delivers mild electrical pulses to the spinal cord, modulating pain signals before they reach the brain. It is the most evidence-supported interventional treatment for FBSS. Candidates typically undergo a trial period with external leads before committing to permanent implantation, allowing them to evaluate the effectiveness for their specific pain pattern.
Can I try spinal cord stimulation before permanent implantation?
Yes — this is standard practice. A SCS trial (temporary placement of leads with an external stimulator) is performed first to evaluate effectiveness. If you achieve sufficient pain relief during the trial, the permanent system is implanted. The trial typically lasts 5–10 days and gives both you and Dr. Migdale valuable information about how well SCS will work for your specific pain.

Medical Disclaimer: The information on this page is intended for general educational purposes only and does not constitute medical advice. It is not a substitute for professional medical evaluation, diagnosis, or treatment. Please consult Dr. Migdale or another qualified healthcare provider regarding your specific condition.

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