What is Post-Laminectomy Syndrome?

Post-laminectomy syndrome, sometimes referred to as failed back surgery syndrome (FBSS) or simply failed back syndrome, is a condition defined by persistent pain in the neck or back following spine surgery. Particularly, post-laminectomy syndrome is connected with a back surgery called a laminectomy. A laminectomy is a type of spine surgery in which a section of the vertebra (lamina) that covers the spinal canal is removed to reduce pressure on the spinal cord or nerves. The main goals of spine surgery are to relieve pain and improve spine stability. Pain is usually relieved by taking the pressure off a compressed spinal nerve.

Anatomy of the Spine

The human spine provides support to the body, allowing you to stand upright, bend and twist. The spine can be broadly divided into the cervical, thoracic, and lumbar spine. Twenty-four spinal bones called vertebrae are stacked on top of one another to form a spinal or vertebral column. Between two vertebrae is a disc of cartilaginous tissue called the intervertebral disc. The intervertebral disc acts as a shock absorber and protects the spine from the strong forces of movement during activities such as jumping, running, and lifting. A cylindrical bundle of nerve fibers called the spinal cord passes through the entire vertebral column and branches out to the various parts of our body. Any damage or deformity to the bones of the vertebral column or to the discs present between the vertebrae can damage these nerves, leading to pain in the body part that the nerve supplies.

Types of Post-Laminectomy Syndrome

There are 3 types of post-laminectomy syndrome that mostly affect the 3 major regions of the spine:

• Cervical post-laminectomy syndrome resulting from the cervical part of the spine (C1-C7)
• Thoracic post-laminectomy syndrome resulting from the thoracic part of the spine (T1-T12)
• Lumbar post-laminectomy syndrome resulting from the lumbar part of the spine (L1-L5)

Causes of Post Laminectomy Syndrome

Persistent pain after a spinal surgery may be due to several causes. One most common and prominent cause is the development of scar tissue (epidural fibrosis) following back surgery which compresses nearby nerve roots and causes pain. Other causes may include:

• Progressive degeneration of the spine
• Incomplete removal of the lamina
• Recurrent disc herniation
• Surgical intervention at the wrong spinal level
• Infection at the disc space or epidural space
• Structural spinal column changes
• Facet joint problems
• Spinal instability
• Failure of the back surgery

In some instances, the spinal nerve root just does not completely recover from its previous trauma after surgery and continues to be a source of chronic nerve pain or sciatica.

Symptoms of Post Laminectomy Syndrome

Some of the common symptoms connected with post-laminectomy syndrome include:

• Persistent dull back, or leg pain
• Continued dull neck, or arm pain
• Sharp, pricking, and stabbing pain in the extremities
• Numbness, weakness, or tingling sensation
• Altered postures and varied positions while walking

Diagnosis of Post Laminectomy Syndrome

In most instances, a history and clinical examination are enough to make a preliminary diagnosis of the post-laminectomy syndrome. However, sometimes additional tests may be required to detect other causes such as abscess formation, infection, and residual compression on the spinal nerves following surgery. These tests include:

• X-ray
• Magnetic resonance imaging (MIR)
• Electromyogram (EMG)
• Blood tests

Treatment for Post Laminectomy Syndrome

Treatment options for post-laminectomy syndrome depend upon the individual patient and the level of pain. The main objective of the treatment plan is to help patients achieve long-lasting relief from chronic to severe back pain and regain normal function and quality of life. A patient’s treatment plan may be a combination of conservative treatment methods and innovative procedures including:

• Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are often the commonly used treatment method for post-laminectomy syndrome. Sometimes, they may be used in conjunction with other therapies too.
• Opioids: Prescription opioids, also known as narcotics and painkillers, are strong pain medications used to relieve moderate to severe pain. However, the side effects of long-term opioid use can be dangerous, hence they should only be taken under strict physician guidance.
• Physical Therapy and Specialized Exercises: These rehabilitative exercises are particularly designed to strengthen the muscles supporting the back and to correct posture.
• Spinal Cord Stimulation: This method involves the placement of electrodes into the epidural space of the spinal cord in the region associated with the pain. The electrodes administer an electric current to interfere with pain conduction pathways.
• Facet Joint Injections: This procedure involves the injection of a local anesthetic in combination with anti-inflammatory medication to help relieve both swelling and pain in the back.
• Epidural Nerve Block: This procedure blocks pain signals by injecting anesthetic medication into the epidural space of the spinal column. The patient may be given up to 3 injections over a period of 6 months for effective treatment.
• Radiofrequency Neurotomy: This procedure employs radiofrequency waves to produce heat or thermal energy where the heat produced deadens or damages the nerves transmitting pain signals to the brain. The procedure usually provides pain relief for 6 to 12 months.
• Specialized Inhibitors: This is a special process that fights a chemical mediator (TNF-a), which can be a cause of inflammatory spinal pain.
• Adhesiolysis: This is a procedure to disconnect or remove any fibrotic scar tissue that may have developed after surgery. The scar tissue can be removed either chemically or mechanically.