Up to 20 percent of the Americans who undergo spinal surgery each year experience some degree of persistent back or neck pain that can also affect the arms and legs – this pain is Post-Laminectomy Syndrome. The symptoms vary widely but post-laminectomy syndrome can describe any lingering pain of unknown origin following back surgery.
What Is Post-Laminectomy Syndrome?
Post-laminectomy syndrome, sometimes called failed back syndrome or failed back surgery syndrome, is a condition characterized by chronic back or neck pain following surgery. Specifically, post-laminectomy syndrome is associated with a back surgery called a laminectomy.
A laminectomy is a type of spine surgery that removes the posterior portion of the vertebra (lamina) that covers the spinal canal to create space. Also known as decompression surgery, laminectomy enlarges the spinal canal to relieve pressure on the spinal cord or nerves.
There are some 500,000 spinal surgeries in the United States every year. Unfortunately, about 20% of those patients suffer some form of ongoing back pain following spinal surgery. This lack of post-surgical pain relief is known as post-laminectomy syndrome.
What Causes Post-Laminectomy Syndrome?
Recurring pain following spinal surgery can be the result of many different factors. Unfortunately, the exact cause of post-laminectomy syndrome is not known. One prominent theory is that the development of scar tissue following back surgery compresses nearby nerve roots and causes pain.
Post-laminectomy syndrome most commonly occurs following a spinal fusion, but can also be caused by:
- Epidural fibrosis (scarring).
- Surgical intervention at the wrong spinal level.
- Incomplete removal of the lamina.
- Recurrent disc herniation.
- Structural spinal column changes.
- Infection in the disc space or epidural space.
- Progressive degeneration of the spine.
- Inflammation of the arachnoid, the membrane that surrounds the spinal cord (Arachnoiditia).
In some cases, the spinal nerve root simply does not fully recover from its prior trauma following surgery, and continues to be a source of chronic nerve pain or sciatica. Furthermore, if the source of the back pain is chemical, surgery might not relieve the pain, and could exacerbate the pain resulting in post-laminectomy syndrome.
What are the Symptoms of Post-Laminectomy Syndrome?
Common symptoms associated with post-laminectomy syndrome include:
- Similar pain you experienced prior to surgery (depends on each case).
- Dull and achy pain that is primarily located in the spinal column following surgery.
- Sharp, pricking, and stabbing pain – commonly referred to as neuropathic pain.
- Sharp pain in the legs.
How is Post-Laminectomy Syndrome Diagnosed?
Post-laminectomy syndrome can be similar to several types of pain disorders, making an accurate diagnosis to determine the correct source of pain vital to successful treatment. To do so, a physical examination along with imaging tests such as an X-ray, Magnetic Resonance Imaging (MRI) or Electromyogram (EMG) will help pinpoint the cause of the back pain and help with planning the proper treatment.
How is Post-Laminectomy Syndrome Treated?
Treatment options depend on the individual patient and the amount of pain. The treatment can include a specific array of conservative measures and innovative procedures. Some of the possible treatment options include:
- Anti-inflammatory medications. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in conjunction with other therapies. In some cases, they may be the only treatment needed.
- Physical Therapy and specialized exercises. Exercise and therapy specifically designed to correct posture and strengthen the muscles supporting the back.
- Opioids. Opioids may be used for pain management; however, responses are unpredictable. The side effects of long-term opioid use can be dangerous, and long-term outcomes aren’t well understood.
- Spinal Cord Stimulation. The placement of electrodes into the epidural space of the spinal cord in the area associated with the pain. The electrodes apply an electric current to interfere with pain conduction pathways.
- Epidural Nerve Block. The use of an injection of medication into the epidural space of the spinal column. Up to three injections may be given over six months.
- Facet Joint Injections. An injection of a local anesthetic in combination with anti-inflammatory medication can help relieve both pain and swelling in the back.
- Radiofrequency Neurotomy. The deadening of nerves with thermal energy. The procedure typically provides pain relief for six to twelve months.
- Adhesiolysis. A special process to disconnect any fibrotic scar tissue that may have developed following surgery. The scar tissue can be removed either mechanically or chemically.
- Specialized inhibitors. A process that combats a chemical mediator (TNF-a), which can be a cause of inflammatory spinal pain.
How to Avoid Post-Laminectomy Syndrome
Researchers believe that individuals who smoke are more likely to develop post-laminectomy syndrome following back surgery. Recent studies show that cigarette smokers are less likely to experience the eradication of pain after spinal surgery. Scientists also believe that nicotine interferes with bone metabolism, and smoking may lead to increased scar tissue buildup by constricting the diameter of blood vessels.
Since smoking may lower the likelihood of successful outcomes, some surgeons will not perform back surgery on anyone who actively smokes cigarettes. In fact, there is an association between cigarette smoking, back pain, and chronic pain syndromes of all types. Fortunately, there are many smoking cessation programs available, including nicotine replacement therapies.
Novus Spine & Pain Center
The pain experts at Novus Spine & Pain Center in Lakeland, Florida specialize in treating pain of post-laminectomy syndrome. By using a comprehensive approach and cutting edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.
Post-Laminectomy Syndrome Resources
Post-Laminectomy Syndrome – The Spinal Nerve Root Does Not Recover from Trauma (TreatingPain.com)
Cervical Post-Laminectomy Syndrome (University Pain Medicine Center)
Post-Laminectomy Syndrome (WakeSpine.com)
Failed Back Syndrome (Wikipedia)
Ask the Expert: Post-Laminectomy Syndrome (Hospital for Special Surgery)