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and then resolve. It will resolve. The reason for the pain is that the nerve root had been compressed for sometime before surgery. Surgery removes the compression. After surgery the nerve root swells leading to the temporary return of pain. If the swelling is thought to be large then a trial of steroid anti-inflammatories might be tried. Surgery may only address one small part of the problem. The rest must be tackled with long-term back care. Back care after surgery may involve continued treatment of the facets and muscles.
FAILED BACK SYNDROME
There are times when despite careful testing, matching of symptoms with clinical findings the pain does not resolve enough. If the problems continue to affect the activities of daily living and there are no other found causes then a treatment option may be a Spinal Cord Stimulator. This device is implanted onto the spinal cord in the lower mid back. It's programmable stimulus delivers continuous treatment to the dorsal columns of the spinal cord. People describe this as a "hum" feeling. It is first tested by implantation through the skin. If it delivers appropriate relief over several days it can be permanently inserted. It is connected by a wire to a small pacemaker like generator that is implanted in the skin of the abdomen. The generator will need to be changed every three to five years depending upon its use. The generator can be turned on and off by a hand held magnet. Even though the spinal cord stimulator covers the chronic pain it does not prevent the transmission of acute pain such as stepping on a pin or a burn. The spinal cord stimulator helps with most leg pain as high as the buttocks. It is not meant for back pain or other pain. In these circumstances a Pain Medication Pump may be inserted. This slightly bigger round pump is inserted into the tissue in the lower abdomen. A catheter delivers medication continuously to the fluid filled sac surrounding the brain and spinal cord. The medication is far more concentrated at the pain perceiving sites in the brain and spinal cord, than if taken by mouth or injected. The pain medication does not get into the systemic circulation the way that oral or intravenous medication does. The pump holds a limited supply of medication that needs to be refilled at least every three months. If narcotics are used in this pump, an escalation of dosage is usually anticipated. This form of pain therapy is tried after all else has failed. It will cover multiple sites of persistent pain. As with all treatments do not expect to be pain free. It is important to continue basic back care for the remainder of life. The back deteriorates over time. Once it deteriorates it cannot be made new or young again.BACK REHABILITATION
Medicine and surgery can only do so much for the back that has been weakening over time. There are circumstances when nothing helps. During these times it is necessary to try to learn the best way to live with the problem. If the patient is still employed, Work Hardening is performed. This is a valuable service that lets the patient learn the limitations that will help with the rest of the life. This will be followed with an Independent Medical Examination for a permanent disability rating. The timing of the rating is controversial. It should be completed when the patient reaches maximal medical improvement from the surgery or injury. Sometimes it is done at three months other times it is completed at one year from injury or surgery or final treatment. This rating affects the career, limiting what will be allowed to perform. At that time chronic back care at home is the course of action.
CONCLUSION
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