What Is Post-Laminectomy Syndrome?
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The back consists of an intricate network of muscles, bones, nerves, and other tissues that run from the pelvic bone up to the neck. 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 allowing for flexibility. The lamina are broad plates of bone that arch over the spinal nerves, providing extra protection. Ligamentum flavum provides cushioning and is found between the lamina. The spinal cord descends from the brain through the spinal column, to just below the rib cage in an average adult.
During a laminectomy, lamina and any bone spurs are removed. The goal of this surgery is to reduce pressure on the spinal nerves caused by various spinal conditions.
Pain associated with post-laminectomy syndrome may be similar to the pain experienced by a patient prior to surgery. Symptoms of post-laminectomy syndrome will differ from patient to patient, although it is often described as a dull ache, or as a sharp, stabbing pain. Patients may also report sensitivities to heat or sensations of pressure.
Causes Of Post-Laminectomy SyndromeResearch to date on post-laminectomy syndrome has been inconclusive. There is no definitive reason as to why back pain persists following surgery. However, it is believed that scar tissue formation following surgery may compress nerve roots, and may explain the chronic pain that patients report with post-laminectomy syndrome.
There are a number of other acceptable explanations for post-laminectomy syndrome, including:
- Surgery carried out at the incorrect spinal level
- Incomplete removal of the lamina
- Inflammation of the areas surrounding the spinal cord
- Other issues that can affect surgical outcomes, including mental health issues
Treatments For Post-Laminectomy SyndromeTreating post-laminectomy syndrome can be difficult as the cause is often unknown. Patients are encouraged to discuss their symptoms in detail with their physician to develop the most effective treatment plan to manage their pain.
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 as they help to decrease inflammation of the affected area, thus resulting 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 to reduce inflammation and pain.
For patients that 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.
Patients that suffer from pain that is severe or chronic may benefit from more intensive forms of treatment, including epidural steroid injections. This type of therapy has been shown to provide significant pain relief. Spinal cord stimulation is another treatment that has been shown to provide significant pain relief. It involves inserting a device that emits electrical impulses near the spine. This device sends impulses that help to control pain signal transmission from the spinal nerves, thereby reducing pain.
An alternative, minimally invasive treatment that has been shown to provide pain control is transcutaneous electrical nerve stimulation (TENS) therapy. TENS units are small devices that have electrodes that are placed on the skin’s surface. These electrodes deliver a very small electrical stimulation to the affected area.
ConclusionPost-laminectomy syndrome results from a failed laminectomy procedure, which is a type of back surgery. Patients suffering from post-laminectomy surgery report persistent pain after surgery or report pain that begins following surgery. While the pain experienced from one patient to the next differs, the pain may be similar to the pain experienced before surgery.
Treating post-laminectomy syndrome can prove to be difficult as the cause is often unknown; however, various treatments exist for chronic back pain. Patients should discuss different options with their physicians to develop the most effective treatment plan for their condition.
- Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L. Interventional techniques: Evidence-based practice guidelines in the management of chronic spinal pain. American Society of I Pain Physicians. Pain Physician. 2007;10(1):7-111.
- Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: A comprehensive, evidence-based review. Reg Anesth Pain Med. 2013;38(3):175-200.
- 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.
- 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.
- Shipton EA. Low back pain and the post-laminectomy pain syndrome. S Afr Med J. 1989;76(1):20-3.
- Teixeira MJ, Yeng LT, Garcia OG, Fonoff ET, Paiva WS, Araujo JO. Failed back surgery pain syndrome: Therapeutic approach descriptive study in 56 patients. Rev Assoc Med Bras. 2011;57(3):282-7.
- Thomson S. Failed back surgery syndrome: Definition, epidemiology, and demographics. Brit J Pain. 2013;7(1):56-59.