Challenges of Persistent Post-Surgical Pain
Persistent post-surgical pain affects a significant proportion of patients undergoing spine surgery, with incidence rates up to 20–30%. Causes include scar tissue formation, biomechanical alterations, and central sensitization.
Pharmacological strategies often provide inadequate relief or are limited by adverse effects, particularly with long-term use.
Chronic post-surgical pain significantly impairs quality of life, reducing mobility, independence, and sleep.
Interventional approaches such as radiofrequency ablation (RFA) provide targeted disruption of nociceptive pathways, offering an evidence-based alternative for refractory cases.
Application in Post-Lumbar Fusion Pain
Post-lumbar fusion patients frequently develop adjacent segment pain, particularly facetogenic pain at levels above or below the fused vertebrae. This “adjacent segment disease” is a leading cause of failed back surgery syndrome.
Nimbus Stratus, with its multitined expandable electrode design, enables extended lesioning of medial branch nerves innervating the lumbar facet joints, even in anatomically altered regions.
The procedure is performed under local anesthesia and fluoroscopic guidance, targeting medial branches L2–L5 based on fusion level.
This approach reduces residual pain, supports clinical stabilization, and enhances participation in rehabilitation programs.
Clinical Evidence and Case Reports
Prospective studies on post-surgical lumbar pain have demonstrated that RFA can achieve significant pain reduction (≥50% NPRS) and functional improvement up to 12 months.
Case reports describe successful use of multitined electrodes in patients with complex post-fusion anatomy, highlighting the adaptability of Stratus technology.
Evidence also suggests that RFA reduces the need for long-term pharmacotherapy and lowers recurrence rates compared with conservative management alone.
These findings support Nimbus Stratus as an effective tool for managing persistent pain after lumbar surgery.
Advantages Over Pharmacological Management
Drug therapy for chronic post-surgical pain is often limited by tolerance, gastrointestinal side effects, cognitive impairment, and opioid dependency.
RFA provides prolonged relief without systemic drug exposure, reducing medication burden and improving compliance.
By decreasing reliance on pharmacotherapy, Stratus contributes to safer, more sustainable long-term pain management.
This advantage is particularly valuable in rehabilitation settings, where minimizing drug use facilitates functional recovery.
Preventing Pain Chronification
A central goal in managing post-surgical pain is preventing its transition to chronic pain syndromes. Untreated persistent pain can evolve into complex central sensitization, making control more difficult.
Early interventional treatment with RFA in refractory cases reduces the risk of pain chronification and associated disability.
Repeatability of Stratus procedures ensures continued efficacy in cases of recurrence, further preventing chronic pain progression.
This approach not only alleviates pain but also preserves functional abilities in the long term.
Guidelines for Rehabilitation Centers
Rehabilitation centers should integrate RFA into multidisciplinary treatment pathways for patients with persistent post-surgical pain.
Nimbus Stratus is indicated in patients with positive diagnostic blocks who have failed pharmacological and physical therapy interventions.
Pre-procedural assessment, standardized protocols, and systematic outcome monitoring with validated tools are essential for safe integration.
Incorporating Stratus into rehabilitation pathways ensures comprehensive, patient-centered management of post-surgical pain.
References
- Burnham R., Wright E., Allan J., Bainbridge J. Comparison of Lumbar Facet RF Neurotomy: Conventional vs. Multitined. Pain Medicine, 2015.
- McCormick Z., Sayed D., Strand N., Racz G. Prospective Cohort Study of Radiofrequency Ablation for Post-Lumbar Fusion Pain. Regional Anesthesia and Pain Medicine, 2017.
