Post Laminectomy Syndrome

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Post Laminectomy Syndrome 2017-09-20T15:55:20+00:00

What Is Post Laminectomy Syndrome?

Post laminectomy syndrome refers to chronic and unexplained pain you experience after back surgery.

If you’re suffering from neck or lower back pain of an unknown origin that develops following surgery, it could be post laminectomy syndrome. This painful syndrome is also known as failed back surgery syndrome. Post laminectomy syndrome is associated with a specific type of back surgery called a laminectomy.

Why Does Back Surgery Fail?

Why back surgery sometimes fails comes down to the back’s structure.

Your back runs from your pelvic bones all the way through to your neck. It consists of an intricate network of muscles, bones, nerves, and other tissues. These include:

  • Spinal column
  • Vertebrae
  • Spinal nerves
  • Lamina
  • Ligamentum flavum
  • Spinal cord

The spinal column provides support and protection for the fragile spinal cord, as well as the spinal nerves.

The vertebrae of the spine are linked together and allow for flexibility. The lamina are broad plates of bone that arch over the spinal nerves, providing extra protection. Ligamentum flavum provides cushioning. These sit between the lamina. The spinal cord descends from you brain through the spinal column, to just below the rib cage in an average adult.

During a laminectomy or back surgery, your doctor may remove lamina and any bone spurs. The goal of surgery is to reduce pressure on your spinal nerves. Various spinal conditions can cause this pressure.

But, since this is such an intricate network, surgery can fail at providing relief. In fact, post laminectomy syndrome pain may actually be similar to the pain experienced prior to surgery! Fortunately, you do have options for relief.

Post Laminectomy Syndrome | PainDoctor.com

Post Laminectomy Syndrome Symptoms

Symptoms of post laminectomy syndrome will differ from patient to patient. For most, patients suffer from:

  • Dull aching pain in the back or neck, especially at the site of the surgery
  • A sharp, stabbing pain in the extremities
  • Sensitivities to heat or sensations of pressure
  • Increase in depression or anxiety
  • Inability to sleep
  • Hyperalgesia, or heightened pain sensitivity

Causes Of Post Laminectomy Syndrome

Research on the causes of post laminectomy syndrome has been inconclusive. There is no definitive reason as to why back pain persists after surgery for some patients.

However, it is believed that scar tissue forms during surgery that later compresses nearby nerve roots. This may explain the chronic pain that patients report with post laminectomy syndrome. There are a number of other explanations for this syndrome, including:

  • Surgery carried out at the incorrect spinal level
  • Incomplete removal of the lamina
  • Recurring disc herniation
  • Progressive spinal degeneration
  • Inflammation or infection in the areas surrounding the spinal cord
  • Other issues that can affect surgical outcomes

Risk factors for post laminectomy syndrome

If you undergo back surgery, you may have an increased risk of developing this condition if you:

  • Smoke
  • Suffer from mental health conditions, like depression
  • Have had another failed back surgery in the past

Unfortunately whether one patients suffers from pain and another doesn’t is not largely understood. As the JLR Center for Pain Medicine explains:

“You may have had spinal surgery, recovered well, and now have developed a new and separate problem at an adjacent level. Or you may have had spinal surgery, and despite the procedure being successful, you are experiencing unchanged or worsened pain. Finally, you may have had spinal surgery and developed some type of post-procedure complication such as nerve damage, infection or a failure for the surgery to achieve the intended anatomical goal.”

Do I Post Laminectomy Syndrome?

Before treatment, you need a diagnosis. As the University Pain Medicine Center explains, the first step is visiting your doctor.

“A physical examination will be completed followed by imaging tests such as an X-ray, Magnetic Resonance Imaging (MRI) or Electromyogram (EMG) to.  These tests are done to pinpoint the cause of your back pain and help with treatment planning.”

Once your doctor has finished tests, they can help you determine if you’re suffering from post laminectomy syndrome.

Post Laminectomy Syndrome Treatment

Treating post laminectomy syndrome can be difficult, as the cause for your pain is often unknown.

If you’re suffering from this condition, discuss your symptoms in detail with your pain doctor. With a full list of symptoms, they can begin to develop the most effective treatment plan to manage your pain. Treatments for post laminectomy syndrome may include:

  • Physical therapy
  • Medications, such as NSAIDs or antidepressants
  • Epidural steroid injections
  • Spinal cord stimulation
  • Radiofrequency ablation
  • TENS therapy
  • A mixture of these therapies

Post Laminectomy Syndrome | PainDoctor.com

Physical therapy 

The Neurosurgical Associates note that physical therapy: “may be recommended by the treating physician as physical therapists can prescribe exercises and treatments such as electrical stimulation which can help relieve pain and improve overall movement.”

Physical therapy is a great option to do alongside other treatments. While undergoing therapy, for example, you may use medications or TENS therapy. After you’ve resolved the cause of your pain, you can eventually taper your need for other treatments.

Medication

Over-the-counter pain medication may provide pain relief for individuals suffering from mild pain. Non-steroidal anti-inflammatory medications are often useful for individuals suffering from moderate pain. These help to decrease inflammation of the affected area and can result in pain relief.

Additionally, there are a variety of antidepressant medications that have recently been shown to provide pain relief in addition to their antidepressant effects. Furthermore, cortisone and prednisone are oral steroids that are sometimes prescribed. These can reduce inflammation and pain.

For patients who do not report pain relief with typical pharmacological management, opioids, including codeine, may help to relieve their pain. Opioids work in the brain by attaching to the opioid receptors. Research has shown that opioids are effective for the relief of acute, severe pain. However, opioids are associated with the risk of dependence and abuse and are not recommended for continued use.

Interventional treatments

Patients suffering from severe and chronic pain may benefit from more intensive forms of treatment.

One of the best options are epidural steroid injections. This type of therapy can provide significant pain relief. It’s also minimally-invasive. Your doctor can perform it in an outpatient setting. The following video gives a great in-depth overview of this treatment option.

 

Spinal cord stimulation is another treatment that has been shown to provide measurable pain relief. This treatment involves inserting a device that emits electrical impulses near your spine. This device sends out electrical impulses near painful areas. These impulses help control pain signal transmission from the spinal nerves, thereby reducing your pain.

A patient talks about spinal cord stimulation helped with her lower back pain in the following video.

 

As ePain Assist notes, radiofrequency ablation is another treatment option. They note that “studies have shown this treatment to be quite effective in more than 50% of cases.” The following video shows exactly how radiofrequency ablation works, in a live demonstration.

 

Finally, another alternative, minimally-invasive treatment is transcutaneous electrical nerve stimulation (TENS) therapy. TENS units are small devices that are similar to spinal cord stimulation, except they go on top of the skin. Electrodes are placed on the skin’s surface. These electrodes deliver a very small electrical stimulation to the affected area. Like spinal cord stimulation, this can interrupt pain signals.

Conclusion

Post laminectomy syndrome results from a failed laminectomy procedure (a type of back surgery). Patients suffering from post laminectomy surgery report persistent pain after surgery. While the pain experienced from one patient to the next differs, the pain may be similar to the pain they experienced before surgery.

Treating post laminectomy syndrome can be difficult. The cause of the pain is often unknown and surgery has failed to help. However, various treatments exist for chronic back pain. Patients should discuss different options with their pain doctor to develop the most effective treatment plan for their condition.

If you need help with your lower back and neck pain, and think it may be caused by a previous surgery, it’s time to find help. Click the button below to find a pain specialist in your area. They’ll be able to diagnose the cause of your pain and suggest treatments that work.

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References

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  3. Epter RS, Helm S, Hayek SM, Benyamin RM, Smith HS, Abdi S. Systematic review of percutaneous adhesiolysis and management of chronic low back pain in post lumbar surgery syndrome. Pain Physician. 2009;12(2):361-78.
  4. Parr AT, Manchikanti L, Harmeed H, Conn A, Manchikanti KN, Benyamin RM, Diwan S, Singh V, Abdi S. Caudal epidural injections in the management of chronic low back pain: A systematic appraisal of the literature. Pain Physician. 2012;15(3):E159-98.
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