Are You Suffering from Failed Back Syndrome?

Failed back syndrome? Failed lower back treatment syndrome? Failed-back surgery syndrome (FBSS)? Are those real things? Yes, and they affect millions each year.

Failed Back Syndromes are a very prominent health problem today. This refers to those suffering from continued or worsening lower-back pain even after extensive and exhaustive treatments all the way up to and including back surgery.

The fact remains that low back pain is the number one cause of disability world wide and patients often end up in surgery where the failure rate ranged from 20-40% according to the Journal of Pain Research. So before you become a statistic, learn how your back works and how to avoid unnecessary treatments, interventions and surgeries. Read more for Dr. Kai Tiltmann’s approach below.

The Many Mysterious Sources of Lower-Back Pain

Lower-back injuries often occur without notice, stemming from moving through life without a good understanding of how the back works. You couple common back misuse with poor fitness instruction, outdated or incorrect internet information and even medical professionals unfamiliar with lower-back pain, and the result is a problem affecting millions.

People who exercise regularly, do manual labor, or have active lifestyles tend to encounter more pain. (The notable exception to this would be office workers who sit incorrectly for hours on end.) Lower-back pain caused by degenerative disc disease, disc herniation or discogenic pain, muscle strain or ligamentous injuries are often the direct result of poor lower-back use. That’s why when someone “throws out” their low back with a seemingly trivial movement, such as putting on their socks, it was most likely a long time coming.

Once pain occurs, people are often treated, coached or instructed (often by uncredited online sources) on simple “solutions" or fixes. These often prevent healing and can even further degrade their condition. Frustration grows as stretches, anti-inflammatory medication, muscle relaxers and more fail to treat the real problem while often aggravating the disc injury, which can lead to a trip to the spine surgeon. Sadly, sometimes patients’ consistent or building pain is even dismissed by others as all in their heads.

How Do You End Up in Surgery?

Patients with chronic lower-back pain, if severe enough and especially in the company of Sciatic (pain down the leg) symptoms, eventually end up being referred to a spine surgeon. Often, this is due to providers running out of treatment options, suspicion of a more serious condition or a medical team simply worn down from patients experiencing pain. When that happens, an MRI is sought to identify conditions, such as a herniated disc or other degenerative findings. But are those pre-surgical findings really the cause of the pain? A study published in the New England Journal of Medicine examined 98 people using MRI who did not have low back pain and found 64 percent had a spinal abnormality of which 52 percent had a disc bulge. So if you have these findings, will surgery be the right answer? Will surgery resolve your pain over the long-term? Once under the knife, there is no going back.

Pre-Surgical Considerations

Here are some items to think about when considering lower-back surgery.

How much time did the surgeon spend with you to help determine the diagnosis (beyond the imaging)?

What physical exam findings helped determine the tissues structures involved?

Have you been thoroughly examined to identify what movements or postures may be causing the pain?

Do you have substantial neurological issues like loss of bowel or bladder control?

Have nerves mobilizing approaches been suggested or completed to rule out a trapped spinal nerve root?

Is the pain unrelenting and severe for a substantial period of time?

Have any pain cycles been identified and appropriately addressed?

Have you been examined for broken bones or torn tissues in need of stabilization?

Have you discussed long-term spine health after disc replacements? As this surgery does not address the two facet joints, long-term spine health may be compromised if these facet joints become arthritic.

Have you discussed the fact that MRI findings are often found in asymptomatic people? This is especially important if a clinic tries to lure you in with “free MRIs” reviews.

Have you explored all conservative options? Different providers have different approaches. Once surgery is undertaken, regardless of how minimally invasive, there will be at least scar tissue, or other potential complications.

Have you been taught proper spinal mechanics, spine sparing movement patterns and exercises that properly stabilize the spine? If not, you will want to learn these concepts before surgery, as they must be applied post-surgery for the best outcome.

There are many outstanding surgeons, doctors and therapist doing amazing work and providing much needed relief and appropriate interventions for their patients. These are not the patients we see.

Dr. Tiltmann’s Approach

  1. Records an extensive history, finds out what movements, positions, and loads cause pain.
  2. Reviews the medical records of prior physicians, physical therapists, x-ray, MRI, CT and surgical reports where available.
  3. Provides an examination that assesses provocative movements, loads and postures.
  4. Provides an explanation of what the provocative movements are and their result on the spine.
  5. Determines the type of treatment and education required.
  6. Sets out a course of action to implement the treatment and education.

Treatment consists of:

  1. Eliminating the cause of pain including errant movements and finding pain free postures and movements.
  2. Teaches postures, techniques and movement patterns that enable pain-free function.
  3. Teaches essential exercises to stabilize the torso, core and spine when moving through life.
  4. Develops a walking plan.
  5. Mobilizes the hips.
  6. Makes daily use of exercises based on patterns of movement: push, pull, carry, sitting, etc.
  7. Teaches healthy spine choices when engaging in activity.
  8. Includes soft tissue work on hypertonic muscles.
  9. Involves mild spinal adjustments as needed, usually not to the lumbar spine.

What to Expect

Failed lower-back back cases are complex, multifaceted, and take extra time and care. The first visit with Dr. Tiltmann is typically two hours and may or may not include treatment. This time is needed to get a thorough understanding of the pain generators. Cookie-cutter approaches, like stretch, do yoga/palates, exercise more, lose weight etc., do not work for these patients with failed outcomes.

Patient treatment outcomes are based on many factors including the severity of lower-back damage, injury duration, symptom severity and involved tissues. We also explore the numbers of therapies and surgeries undergone, as well as age, health and patient fitness.

The lumbar spine is complex, elegant and amazing. It has the unique ability to provide motion at one time and become stiff to bear axial and sheer loads another. If used and trained correctly, it can endure unimaginable loads, as demonstrated by Olympic lifters. If used and trained incorrectly, it can make our life a living hell.

If you are a failed lower-back treatment patient, come and experience the difference yourself. You will be glad you did.

If you wish to be seen in Dr. Tiltmann’s San Francisco office, please click here


Concierge Service

For patients that live outside the San Francisco Bay Area or simply want Dr. Tiltmann to come to them for; assessment, education and treatment, there is a novel solution. Dr. Tiltmann will travel to your California location on a weekend. (Patient Qualification required – see below)

Medical Tourist

Dr. Tiltmann is licensed to practice in California, USA
For those patients traveling to San Francisco to be treated they can schedule with Dr. Tiltmann during a weekend at his San Francisco office. Please provide your own interpreter if not fluent in English. (Patient Qualification required – see below)

Additional Visits

If the patient requires or requests follow up visits to review exercises, movements, instructions, treatment recommendations, etc., appointments can be made at the San Francisco office, or an additional concierge visit can be arranged. Telephone consultations are also available.

Patient Qualification for Concierge Service & Medical Tourist

In order to ensure that Dr. Tiltmann has the highest possibility of success and that the patient is a good candidate for this treatment, patients must provide their medical records. That includes all medical records relating to the lower back, and other conditions that may affect outcomes (such as diabetes for example), including all surgeries, past and current medications, all imaging including MRI/CT/Bone Scan/X-rays and mail them for case review. This service requires the payment of the qualifying fee. If your case is accepted and it looks like Dr. Tiltmann’s services have the highest likelihood of success to reduce or eliminate pain and increase function in the long term an appointment will be scheduled with you.

Fee Explanation for Concierge Service & Medical Tourist

Service Fee:
One weekend day consisting of one 3-hour morning session and one 3-hour afternoon session.

Retainer Fee:
Covers expenses for travel, transportation, food, etc. Any unused portion will be refunded within 60 days of completion of the visit.

Expert Fee:
Any activity preformed by Dr. Tiltmann for the patient that is not listed above is charged separately once the retainer has been exhausted.

All fees are due at the time of booking. The rescheduling or cancellation window is ten days prior to the appointment. The qualifying fee is non-refundable, nor is the retainer fee if the appointment is rescheduled or cancelled with less than 10 days prior notice of the appointment. Appointments will be scheduled once the medial records and been reviewed and the case accepted. A super bill will be provided for proof of payment.

Concierge & Medical Tourist Fees* Price
Qualifying Fee (medical case review up to 2 hours) $498
Service Fee (one day 2 x 3 hour sessions) $2599
Retainer Fee (non-refundable with late cancellation) $749
Expert Fee (per 15 min.) (charges not covered above) $90
Telephone Consultation (per 15 min.) $90

*Payment plans do NOT apply to Failed Back Treatment visits.

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