Failed Back Surgery Treatments: Spinal Pumps and Spinal Cord Stimulation

Your doctor has several treatment options if you’ve been diagnosed with failed back surgery syndrome (FBSS), and neuromodulation therapies—including intrathecal drug delivery systems (IDDS, spinal pumps) and spinal cord stimulation (SCS)—are among the safest and most effective. Spinal pumps and SCS require surgery to implant their respective devices, but they shouldn’t be confused with revision spine surgery to treat failed back surgery (also called FBS and post-laminectomy syndrome).

Pain Pump Technology: Intrathecal Drug Delivery Systems (IDDS)

Back pain is the leading symptom of failed back surgery—and an intrathecal drug delivery system (IDDS), commonly known as a spinal pump or pain pump, carries medication directly to the spinal nerves and spinal cord.
A spinal pump or pain pump, carries medication directly to the spinal nerves and spinal cord.A spinal pump or pain pump, also called an intrathecal drug delivery system (IDDS), carries medication directly to the spinal nerves and spinal cord. Photo Source: PracticalPainManagement.com.When you take medication orally (via the mouth), the medication spreads throughout your entire body. As such, you need a higher dose to ensure the area needing it gets a sufficient portion. But with a spinal pump, the targeted application means it’s highly effective despite a reduced dose compared to oral delivery. Plus, a lower drug dose means lower risk of side effects.

IDDS sends medication through a catheter connected to pump that a surgeon implants under the skin of your abdomen. The medication is sent directly into the spinal fluid near the pain source. The U.S. Food and Drug Administration (FDA) has approved 3 medications for use in intrathecal pumps: baclofen, morphine, and ziconotide.

If you have tried more traditional forms of medication therapy without success, your doctor may consider you a candidate for IDDS therapy. If you are a candidate, you will first undergo a trial for this therapy, in which you stay at the hospital while medication is administered via catheter. This period will help determine the best medication dose for your symptoms.

IDDS is really only appropriate for patients where all other treatments have failed. IDDS is palliative meaning it doesn’t fix the underlying problem. People develop tolerance to narcotics and therefore, IDDS is not likely to result in a lasting beneficial effect. Patients with a limited life expectancy such as patients with terminal cancer may be good candidates.

Once the trial is complete and has been considered a success (by measure of pain relief), your doctor will surgically implant the pump. Your doctor may implant a fixed rate pump or variable rate pump: Variable rate pumps require a battery, so they may need to be replaced.

Spinal pumps need to be refilled with medication at different intervals, though most all should be refilled every 6 months. Your doctor will let you know your specific pump’s maintenance details.

Spinal Cord Stimulation

Spinal cord stimulation (SCS) is another palliative modality for patients. SCS does not fix the underlying problem. It is generally not effective for treating back pain but is helpful for many patients who have burning neuropathic leg pain due to nerve damage.

SCS can alleviate nerve pain by preventing (or interrupting) your nerve’s pain signals from reaching the brain. It achieves this goal using a device called a spinal cord stimulator, which is surgically implanted under your skin (usually in your abdomen or buttock). The device sends electrical impulses that interfere with pain signals before they’re able to be processed by your brain (and felt by you).
Anterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine. Anterior view X-ray of a spinal cord stimulator (SCS) implanted in the thoracic spine. By Mconnell [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons. https://en.wikipedia.org/wiki/Spinal_cord_stimulator.If your doctor believes you are a candidate for this surgery (like IDDS, you will most likely need to try more conservative treatments before moving on to SCS), you will first undergo an SCS trial before having a spinal cord stimulator permanently implanted.

If the trial is deemed successful (by measurement of pain relief), you will have a spinal cord stimulator permanently implanted. The procedure to implant your device will be performed in a hospital or outpatient surgery center by your spine surgeon or pain medicine specialist. The surgical procedure usually takes less than 90 minutes.

Neuromodulation Therapy: Safe, Long-term Solutions for Failed Back Surgery

Neuromodulation treatments like intrathecal drug delivery systems (spinal pumps) and spinal cord stimulation (SCS) are options for patients that have failed all other treatments and are not candidates for further spine surgery. This is especially important considering the increased scrutiny over opioid pain relievers (eg, pills, transdermal patches).1

Another plus for spinal pumps and SCS is that you may trial the therapies before having them permanently implanted (if necessary, either device can be removed). While these treatments have strong research support for their efficacy, they may not be appropriate for every person with FBS, and your doctor may want to try more conservative therapies before opting for these treatments. They are generally options for patients who are not candidates for any surgery.

Updated on: 02/06/19
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