Interventional Treatments for Failed Back Surgery Syndrome: Radiofrequency Ablation and Adhesiolysis

Failed back surgery (also called FBS, failed back surgery syndrome, FBSS, and post-laminectomy syndrome) is a complex condition—and your doctor has a wide range of treatments to help address your pain after spine surgery. Some of the therapies your doctor may recommend are interventional pain management treatments, which include radiofrequency ablation and adhesiolysis. After spine surgery, scarring in the epidural space can prevent the effectiveness of subsequent lumbar epidural injections. Therefore, interventional treatment options may be limited.

Your doctor may opt to use one of these interventional treatments for your FBS symptoms, or he or she may use a combination of both to maximize your pain relief.
Lumbar spine, horizontal view.Treatment of FBSS may include interventional pain management therapies targeting spinal nerves, joints and/or scar tissue. Photo Source:

What Is Radiofrequency Ablation?

Radiofrequency ablation (RFA) is a treatment your doctor may recommend for failed back surgery syndrome if you have joint or nerve pain. This treatment is often used to treat people whose pain stems from the facet joints in their neck or back, or the sacroiliac (SI) joints. Since this procedure doesn’t rely on the epidural space where there is scarring, it may be more likely to be used after spine surgery.

RFA goes by several names, including RF ablation, radiofrequency rhizotomy, radiofrequency neurotomy, and radiofrequency lesioning. The layperson version of this is “burning the nerves.” Regardless of the term your doctor uses, the concept behind this minimally invasive treatment is the same: It uses radio waves to heat up the tissue and temporarily prevent nerves from sending pain signals to the brain. The nerves involved are the tiny nerves that innervate the lumbar facet joints and not the nerves that go down the legs and control your movement.

Because RFA temporarily prevents nerves from transmitting pain messages, relief is also temporary—symptoms are typically relieved for 3 to 6 months. Results vary and many patients get no relief from these procedures.

Several types of RFA exist: Some target specific nerves (such as medial branch neurotomy and lateral branch neurotomy), some use heat to disable nerves (like thermal or conventional RFA, and pulsed ablation), and some use water (such as water-cooled or cooled RFA). Your doctor will choose the best type of radiofrequency ablation to address your pain.

What Is Adhesiolysis?

A build-up of scar tissue is among the most common causes of failed back surgery syndrome, as scar tissue often forms when your body is trying to heal itself after surgery. If scar tissue is behind your FBS, your doctor may recommend a procedure called adhesiolysis (also known as epidural lysis of adhesions, epidural LOA, epidural neurolyosis, and the Racz procedure).

Adhesiolysis is also called the Racz procedure after Dr. Gabor Racz, who invented the technique for removing scar tissue around trapped nerves in the lumbar spine (low back).

During adhesiolysis, you will lie on your stomach, and your doctor will use fluoroscopy (real-time imaging) and an injection of contrast dye to view the scar tissue in your spine. You may be locally sedated, so you will feel little or no pain during the procedure. The procedure takes between 30 and 60 minutes, and it’s performed in an outpatient setting (so, you’ll be able to go home the same day).

If your doctor sees that swollen, irritated spinal nerve roots are the true source of your pain (not scar tissue), then he or she may inject a powerful anti-inflammatory medication (eg, epidural steroid injection) to ease pain caused by the compressed nerve root. While steroids may effectively reduce inflammation, they cannot eliminate scar tissue.

Scar tissue is not a cause for ongoing back/leg pain. All patients who have had a spine surgery will have some scar tissue. Therefore, if patients have ongoing pain after surgery—scar tissue is blamed for this condition even though the pain usually predated the presence of scar tissue! Adhesiolysis is not a procedure that will address scar tissue in any meaningful way.

If patients have surgery for failed back syndrome, scar tissue will make the surgical procedure more difficult for the surgeon, and risks of complications, such as spinal fluid leakage, are much higher. Removal of some scar tissue may be required to accomplish the goals of the surgery. Repeat surgery is generally never done for the sole purpose of removing scar tissue because again, scar tissue is not the cause of failed back syndrome.

Long-term Relief After Failed Back Surgery with Interventional Procedures

Interventional procedures like radiofrequency ablation and adhesiolysis may offer you sustained relief from pain caused by irritated spinal nerve roots and/or scar tissue build-up. This pain relief may allow you to better engage in other types of failed back surgery treatment, such as physical therapy and exercise, which will further improve your chances of having a good quality of life after failed back surgery syndrome.

Updated on: 02/06/19
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