Post-Laminectomy Syndrome: Causes, Symptoms, Treatment
What Is Post-Laminectomy Syndrome?
Post-Laminectomy Syndrome is the name given to a medical condition in which an individual who has undergone surgical treatment to get rid of back pain fails to achieve the desired result and the pain does not go away. It is also known by the name of Failed Back Syndrome.1 In order to understand this condition better, it is important to understand what laminectomy exactly means. Laminectomy is a surgical procedure in which the vertebrae protecting the spinal cord are removed to release pressure that is caused due to a disc protrusion. Under normal circumstances, individual who has undergone this surgery recovers without any potential complications but in some instances this procedure is considered as a failure and the pain does not resolve or may even get worse. This is what is called as Post-Laminectomy Syndrome.
What Causes Post-Laminectomy Syndrome?
There can be numerous reasons for the failure of the surgical procedure and the pain does not dissipate following the surgery. One of the causes may be that the surgery was done in haste and may be the pressure put on the spinal cord by the protruding disc was not severe enough to warrant surgery and hence the surgery was a failure. In some cases, patients fail to get relief due to another condition called as spinal stenosis where there is severe narrowing of the spinal canal. In some cases, postprocedure there may be a small piece of disc still remaining in the spinal cord which tends to irritate the cord and result in pain even after the procedure. Studies suggest that Post-laminectomy Syndrome is more prevalent in people who smoke as it delays recovery. People who are at higher risk for developing Post-laminectomy Syndrome are those who have had attempts at surgery to treat back pain before and have been unsuccessful.
What Are The Symptoms of Post-Laminectomy Syndrome?
The main symptom of a Post-Laminectomy Syndrome is that even after a surgical procedure to treat back pain the patient does not get any relief in terms of pain. In fact, there would be no change in the symptoms of the individual pre and postsurgery. There will be aching discomfort in the region of the spinal column which may become sharp and may radiate to the lower extremities. Individuals may also experience hyperalgesia with heat.
Because of persistent pain and failure to get desired results from surgery along with inability to do their household chores effectively, patients with Post-Laminectomy Syndrome tend to go into deep depression and may have frequent anxiety attacks. Their sleep gets disturbed as well due to pain.
How Is Post-Laminectomy Syndrome Diagnosed?
In order to diagnose Post-Laminectomy Syndrome the physician will first take a look at the surgical site, which in cases of Post-laminectomy Syndrome will be tender to deep palpation. The patient will complain of persistent pain in the back radiating down the legs. The patient will also have an abnormal gait due to significant pain in the back. These signs are enough for a physician to diagnose Post-laminectomy Syndrome, but to further confirm the diagnosis the physician will also order radiologic studies like x-rays or MRI scan to look at the internal structures of the spinal cord to see if there are any bone fragments left which may be irritating the spinal cord and causing pain or whether there is any spinal cord compression causing unrelenting pain.
How Is Post-Laminectomy Syndrome Treated?
The classic approach to treat Post-Laminectomy Syndrome is physical therapy and exercises specifically for the back. Pain medications in the form of NSAIDs are also given to calm down the pain to some extent.2 Another way of treating this pain is a medication specifically made to inhibit the chemical TNF-a, which is known to produce back pain. Some of the medications which come under this category are etanercept, Remicade, Humira etc. and they have shown to be helpful for treating Post-Laminectomy Syndrome.
Another form of treatment which has been shown to be effective has been the use of neuromodulator like the spinal cord stimulator. Studies prove that this has been quite successful in treating Post-Laminectomy Syndrome. Epidural Steroid Injections have also been of great benefit in treating Post-Laminectomy Syndrome or Failed Back Syndrome. Another beneficial approach for treating Post-Laminectomy Syndrome has been radiofrequency ablation treatment. Studies have shown this treatment to be quite effective in more than 50% of cases of Post-Laminectomy Syndrome or Failed Back Syndrome.