At The Harley Street Medical Centre, 144 Harley Street, W1G 7LD. 0845 468 1088
or +44 20 3369 8747

Thursday, 16 August 2012 15:42

Failed Back Surgery & Injections

Pain Managment

The standard patient journey for many patients with chronic back and neck pain conditions often starts with a visit to their GP. If a course of anti-inflammatory or pain killing medication fails relieve their symptoms the patient may then be referred for physiotherapy. If symptoms persist after a course of physiotherapy and if surgery is inappropriate “Pain Management may be the next step.

Pain management most often includes pain relieving injections into joints, nerves and other tissues. Such interventions are administered on the assumption that the patient requires the temporary pain relief produced by the injections either so that they can perform rehabilitative exercise that would otherwise be too painful to perform, or because they have a chronic severe degenerative condition that for which they need (on-going) intervention in order to cope with their pain levels. Occasionally this may be combined with other “coping strategies” such as cognitive behavioral therapy.

The problem with this patient pathway is that pain management just focusing on relieving the pain, meaning that in some cases further damage is caused to the painful tissue whilst the patient is in their “pain free window”.  Alternatively the injections may not produce any relief and having already tried previous physical therapy the patient is left thinking there is no hope except perhaps for surgery.

 Furthermore whilst pain medicine doctors, as qualified anesthetists, are experts at administering relieving pain injections they do not receive training in functional biomechanics, manual therapy or rehabilitative exercise. Therefore, particular if a patient has received substandard physiotherapy, they may be referred prematurely for pain management injections without having fully explored all that expert manual therapy has to offer.



Unfortunately spinal surgery does not always provide the improvements desired by patients and surgeons. Whilst the success rate for “ideal” candidates undergoing surgical procedures such as microdiscectomy are reported as being over 90% for relieving sciatic pain in the leg, due the complexities of the spine such surgery does not carry such a high success rate for relieving back pain.

Furthermore, depending on the exact type of incision, the amount of weakening caused to the outer disc wall from the incision and the amount of inner disc material (nucleus pulposus) excavated from the disc, even minimally invasive spinal surgery caries varying risks of re-occurrence of disc protrusion and other complications in the months and years following surgery such as postoperative scarring and reduction in disc height with consequential increased wear placed on adjacent structures such as the facet joints.


Treatment and rehabilitation at The Harley Street Spine Clinic

Non invasive alternatives to surgery and injections include IDD Therapy (Computerised Spinal Decompression) this is a non invasive extremely low risk therapy involving targeted distraction at a specific segment(s) of the spine in order to offload the discs and spinal structures. Even clients who have undergone previous failed spinal surgery IDD may be often be candidates for IDD Therapy.

There is saying within the medical world that states that “…good surgery may have a bad outcome following bad postoperative rehabilitation (physiotherapy) and bad surgery may have a good outcome if there is good postoperative rehabilitation”.

Our team of physical therapists are experts in their field, furthermore we have several cutting edge physical therapy modalities that may not have been previously offered such as IDD Therapy and Shockwave Therapy, Medical Acupuncture and Clinical Pilates programs (featuring  the Australian Physiotherapy & Pilates Institutes teachings).

Published in Conditions Treated

The Harley Street Spine Clinic | 144 Harley Street, W1G 7LD.
t: 0845 7800 892 | e: This email address is being protected from spambots. You need JavaScript enabled to view it.