Post-Laminectomy Syndrome

What is post-laminectomy syndrome?

Post-laminectomy syndrome is not a diagnosis but rather a general term to describe a variety of chronic pain syndromes experienced by patients as they recover from a specific kind of back surgery called a laminectomy.

Back pain usually originates in the nerves of the spine and the messages they send to the brain. The spine is comprised of vertebra stacked one upon another from the pelvis to the skull. This structure protects the spinal cord and its nerve roots. The lamina is a portion of the vertebrae that connects the spinous process (the protrusions felt on the back through the skin) to the main body of the bone.

When these lamina become irritated and inflamed, a laminectomy procedure removes the lamina and any associated bone spurs to relieve pressure on spinal nerves. The exact cause of post-laminectomy syndrome is unknown, though. One possible cause is epidural fibrosis: a post-surgery development of scar tissue that presses on the nerves and leads to pain.

Other possible causes include:

• Surgical intervention at the wrong spinal level
• Incomplete removal of the lamina
• Arachnoiditis, or inflammation within the protective layers of the spinal cord
• Mental health challenges, such as depression, that interfere with recovery

Because of the diversity of potential causes and a variety of different chronic pain syndromes that can result from failed back surgery syndrome, the condition can be difficult to treat.

Post-laminectomy symptoms

Post-laminectomy symptoms are as broad and varied as the patients who experience them. Most patients experience pain in the lower back, neck, or extremities.

Other symptoms can include:

• Radiating pain
• Sensitivity to heat and cold
• Abnormal nerve response to stimulation
• Feelings of heaviness or weighted legs

More serious symptoms include loss of bowel or bladder control. This should be treated as an emergency with an immediate examination in an emergency room.

Diagnosing failed back surgery pain

Diagnosis of post-laminectomy syndrome is made following surgery if your doctor recognizes a developing pattern of chronic pain and poorer-than-expected post-surgical outcomes.

An MRI or X-ray can look for inflammation or other structural abnormalities where at the lamina removal site.

Because there is a mental health component to recovery from any surgical intervention, your doctor may also perform a mental health screening to rule out any potential mental health challenges that are interfering with your recovery.

5 post-laminectomy syndrome treatments

Your doctor will tailor treatment options to you, as each person will have different symptoms and will respond differently to their ongoing challenges with pain.

There are generally five post-laminectomy syndrome treatments, though.

1. Physical therapy and exercise

Many patients believe that surgery will fix the pain in their back, but rehab after surgery is crucial.

Building up the core stabilizing muscles in the abdomen can help strengthen and lengthen back muscles for better recovery.

2. Antidepressants or other medications

There is a strong link between mental health challenges and pain. For example, in some cases, even patients without a history of depression find relief from failed back surgery symptoms when they take antidepressants.

While opioids used to be prescribed for post-laminectomy syndrome, responses are unpredictable. The side effects of long-term opioid use can be serious, and long-term outcomes aren’t well understood. For these reasons, opioids are usually not a treatment option for chronic back pain.

3. Adhesiolysis

Adhesiolysis (also called lysis of adhesions or the Racz procedure) uses injections to break up scar tissue that may be pressing on nerves and causing pain.

This is helpful in cases where epidural fibrosis is present.

4. Spinal cord stimulation

Spinal cord stimulation may be appropriate for some patients. With this approach, an electric current replaces pain signals with a mild buzzing sensation.

5. Additional surgery

The risk of post-laminectomy syndrome increases when more surgeries are performed, but in some cases, missed lamina can be removed in a second surgery for profound pain relief.

References

1. Rabb, C. (2010). Failed back syndrome and epidural fibrosis. The Spine Journal. Vol 4(4), 486-488.
2. Nidus Information Services. (2011). Laminectomy. Patient Handouts. MD Consult Web site, Core Collection.
3. Rosenbaum, R.; Ciaverella, D. (2008). Disorders of Bones, Joints, Ligaments, and Meninges. Bradley: Neurology in Clinical Practice, 5th Ed. MD Consult Web site, Core Collection.
4. Chou, R. (2011). Subacute and chronic low back pain: Surgical treatment. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
5. Bajwa, Z.; Smith, H. (2011). Overview of the treatment of chronic pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.