The Sciatica Strikes Back
A few weeks ago, a patient came to Red Butte Pain Solutions with severe lower back and leg pain. Years earlier, he had undergone surgery for a herniated disc. After the surgery, he felt better and lived pain-free. But now, the pain had returned. It was similar to what he felt during his previous disc issue, except now it radiated in a new area. This time, the pain was intense and didn’t go away, even after trying some of his old medications and his home exercise program.
The Path to Diagnosis
At first, we started with conservative treatment, as required by most insurance plans. Medication and physical therapy are often the first lines of defense. After several weeks without improvement, we decided to get an MRI. The MRI revealed a new herniated disc above his previous surgery site, a condition known as “adjacent segment disease.” This condition occurs when the levels of the spine near a surgical site undergo extra stress over time, leading to new damage.
What Is Adjacent Segment Disease?
Adjacent segment disease (ASD) is a condition where the discs or joints near a prior spinal surgery site degenerate. This degeneration can lead to similar symptoms, like back pain and sciatica. The spine is a complex structure, and when part of it is surgically treated, the surrounding areas may bear more strain. Over time, this additional load can cause the discs or joints near the surgery site to wear down or herniate, resulting in new pain.
Sciatica, the radiating leg pain often linked to herniated discs, can be one of the most significant symptoms of ASD. The pressure on the nerves from a herniated disc can cause shooting pain down one or both legs. Patients often describe it as a burning, sharp, or tingling sensation. For those who have undergone previous surgery, it can feel disheartening to face similar pain again.
Why Does Adjacent Segment Disease Happen?
The development of ASD is related to the mechanics of the spine. After surgery, the spine’s movement patterns can change. For instance, if a patient has undergone spinal fusion, which stabilizes one or more segments of the spine, the segments above or below the fusion can experience extra wear and tear. Even non-fusion surgeries can shift the way the spine moves, putting added pressure on nearby discs.
Aging also plays a role. Over time, the discs and joints of the spine naturally degenerate, and for some patients, this process happens more quickly near a previously operated area. Repetitive strain from everyday activities can accelerate this breakdown, especially in people who have undergone surgery in the past.
Conservative Treatment for Adjacent Segment Disease
As with many spinal conditions, the first step in treating ASD is conservative management. This involves:
- Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. Muscle relaxants or nerve pain medications like gabapentin may also be prescribed to help ease discomfort. For some patients, medications alone can provide relief from both back pain and sciatica.
- Physical Therapy: Physical therapy plays a critical role in treating ASD. Specific exercises can strengthen the muscles around the spine, improving stability and relieving stress on the affected area. Stretching can help improve flexibility, while core strengthening exercises can protect the spine during daily activities. A physical therapist may also teach patients posture and movement modifications to prevent further strain on the back.
While medication and therapy can help reduce symptoms, some patients may find that conservative measures are not enough. If pain persists or worsens, it may be time to consider more advanced treatments.
Epidural Steroid Injections for Sciatica and Back Pain
For patients who don’t respond to medications or therapy, epidural steroid injections (ESIs) can be highly effective. These injections deliver powerful anti-inflammatory medication directly to the source of the pain, reducing inflammation and easing nerve irritation.
The procedure involves injecting a corticosteroid into the space around the spinal nerves, called the epidural space. ESIs target inflammation in this area, which is often the cause of pain from a herniated disc. In cases of adjacent segment disease, ESIs can provide relief from sciatica, allowing patients to participate more actively in physical therapy and daily activities without debilitating pain.
For many patients, one or two injections can significantly reduce symptoms. ESIs are especially beneficial for those experiencing nerve pain, like sciatica, that hasn’t responded to other treatments.
Surgical Options for Adjacent Segment Disease
When conservative treatment fails, surgery may be the next step. In cases where the herniation is severe or nerve damage is occurring, surgery can provide long-term relief. Surgical options for ASD often depend on the individual patient’s anatomy and history.
One common option is revision surgery, which may involve additional spinal fusion or removal of the herniated disc material. The goal is to relieve pressure on the spinal nerves, reduce pain, and stabilize the spine.
However, not all patients are ideal candidates for surgery. Age, overall health, and previous surgical outcomes all play a role in determining whether surgery is the best choice. For patients who may not be ready for surgery, treatments like ESIs can provide a bridge, offering pain relief while they consider their options, such as spinal cord stimulation.
How to Prevent Adjacent Segment Disease
While ASD can happen naturally over time, there are steps patients can take to help prevent its progression. Maintaining a healthy lifestyle can reduce the stress placed on the spine.
- Stay active: Regular exercise, especially activities that strengthen the core and improve flexibility, can protect the spine.
- Maintain a healthy weight: Excess weight puts extra strain on the spine and can speed up degeneration.
- Practice good posture: Standing and sitting with proper alignment reduces unnecessary stress on the spine.
- Avoid smoking: Smoking reduces blood flow to the spine, slowing down the healing process and increasing the risk of degeneration.
For patients who have already undergone spinal surgery, regular follow-ups with their healthcare provider are essential. Monitoring changes in symptoms and getting imaging tests as needed can help catch issues early, before they become severe.
A Path Forward
For our patient, the journey is still ongoing. After the MRI confirmed adjacent segment disease, we discussed the treatment options available. He decided to proceed with an epidural steroid injection, hoping to avoid a second surgery. Within a week of the injection, he experienced significant pain relief. His sciatica improved, allowing him to return to physical therapy and daily activities without the burden of constant discomfort. As we continue to monitor his progress, we are hopeful that the combination of therapy and injections will keep his symptoms under control.
Adjacent segment disease can be a frustrating and challenging condition, especially for patients who have already undergone back surgery. But with the right treatment plan, it is possible to manage the symptoms and avoid surgery in many cases.
If you or someone you know is experiencing lower back pain or sciatica after a previous surgery, it may be worth discussing the possibility of adjacent segment disease with a healthcare provider. At Red Butte Pain Solutions, we are here to help patients find relief and return to the activities they love.