What is Post-Laminectomy Syndrome?
Post-laminectomy syndrome explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Also known as failed back surgery syndrome, post-laminectomy syndrome is a chronic pain condition affecting patients who have recently undergone back surgery or a laminectomy. This pain condition can result in pain symptoms that persist despite back surgery to relieve the pain, or it can involve new onset symptoms of pain.
It is not precisely known why pain may persist following surgical intervention. Primarily constructed of several individual bones stacked on top of one another is the spinal cord. These bones, known as vertebrae, are separated by intervertebral discs and provide support and flexibility within the spine. They also provide protection for the spinal cord. In order to add an extra layer of protection, shingle-like plates arch over the spinal cord called lamina, with ligamentum flavum acting as a cushion between them. During back surgery, or a laminectomy, the physician will remove the lamina and any bone spurs found that may be the cause of the patient’s pain. Ideally, this helps with relieving pain by reducing the amount of pressure placed on spinal nerves.
This procedure is not always successful, however, in reducing the patient’s pain. Patients may experience a wide range of pain symptoms associated with post-laminectomy syndrome. They may describe their pain as dull and achy or sharp and stabbing. Other symptoms may accompany this pain, such as sensitivities to heat and pressure.
Causes of Post-Laminectomy Syndrome
There is much disagreement about the underlying cause of post-laminectomy syndrome and it is not clearly known what accounts for the patient’s refractory pain. Many believe that scar tissue, which forms following surgery, places pressure upon nearby nerve roots causing significant amounts of pain and irritation. Given that scar tissue does not heal, this can explain why patients with post-laminectomy syndrome are more likely to experience chronic and persistent pain. There are several other explanations for post-laminectomy syndrome, including:
- Incompletely removed lamina
- Surgery that was performed at an improper spinal level
- Inflammation at the protective layers surrounding the spinal cord
- Factors affecting the patient’s ability to recover following surgery, such as anxiety or depression
Treatment for Post-Laminectomy Syndrome
Patients are encouraged to speak with their physician regarding their ongoing symptoms of pain associated with post-laminectomy syndrome following a failed back surgery. Given that the underlying cause of post-laminectomy syndrome can oftentimes be unknown, treatment for the pain can often be somewhat difficult. Nonetheless, there are a number of treatment options available to assist with the pain.
Over-the-counter pain relievers with anti-inflammatory qualities (NSAIDs, such as ibuprofen or naproxen) can be very beneficial for patients with post-laminectomy pain. These medications are believed to be effective because of their anti-inflammatory characteristics. Other medications, such as oral corticosteroids like prednisone and cortisone, may be recommended in instances where the patient’s pain was not significantly reduced using an over-the-counter pain reliever. Some anti-depressant medications have also been shown to reduce the pain associated with post-laminectomy syndrome.
Failed back surgery can be associated with chronic or severe pain that causes significant interference with a patient’s ability to perform necessary daily functions. Patients with these more significant symptoms may wish to try more aggressive forms of pain management available. In terms of patients who report that their pain has not been responsive to over-the-counter pain medications, it may be recommended that they try more aggressive pain management techniques. For instance, opioid medications, such as codeine, may be prescribed for patients needing short-term relief from the pain of post-laminectomy pain. These medications act by binding to the opioid receptors within the brain and have received extensive support for their effectiveness in reducing pain. The risks of using opioids include the potential for addiction; in other words, patients may become psychologically or physically dependent on them.
Should the patient not experience significant relief from pain with other treatments, they may be excellent candidates for more aggressive forms of pain management. For instance, a highly effective and almost immediate option for managing pain following a failed back surgery is receiving epidural injections. This procedure involves the injection of an anaesthetic medication, generally corticosteroids, into the area near the nerve that is primarily responsible for transmitting pain signals to the brain. Other methods, including the use of a TENS unit or spinal cord stimulation, which send a very mild electrical impulse to the affected area, have also been shown to be highly effective in relieving pain associated with post-laminectomy syndrome.
Patients with post-laminectomy syndrome not only can experience ongoing and persistent pain following back surgery, but can also experience new onset symptoms of pain. The pain that these patients experience can also closely resemble the pain that the patient experienced prior to their back surgery. Though it may be difficult for the physician to target a specific underlying cause for the patient’s refractory pain, there are a number of treatment options available. Many of treatment options available are non-surgical and can be done on an outpatient basis. Patients should speak with their doctor about their specific condition and to learn about the treatment options available for managing their pain.
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