Post Laminectomy Syndrome

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Description:

Back surgeries are performed to reduce or eliminate chronic back or leg pain due to spinal nerve compression. Should surgery fail to achieve all of its desired outcomes, the result is known as Post Laminectomy Syndrome (sometimes called Failed Back Syndrome).  This can also occur after neck surgeries, where it is called Post Laminectomy Syndrome, rather than Failed Back Syndrome.

Symptoms:

  • Diffuse, dull and aching pain involving the back and/or buttocks and legs, similar to sciatic pain.
  • When the neck is involved, pain radiates to shoulder areas and down the arms, similar to cervical radiculopathy.
  • Numbness and/or tingling can also be present.

Causes:

  • Residual or recurrent disc herniation, causing persistent pressure on spinal nerve.
  • Joint hypermobility or instability.
  • Scar tissue formation (fibrosis).
  • Permanent damage to spinal nerves, manifested as abnormal sensitization, producing chronic pain.
  • Fixing of one or more spinal joints during spinal fusion may increase the strain on nearby joints (levels above and below), causing pain.
Screening and Diagnosis:

The diagnosis of failed back syndrome is the same as the diagnosis of other forms of back pain. Diagnosis begins with a complete history and physical exam. X-rays, MRI scans, and computed tomography (CT) scans are used to visualize the structures of the back to identify the source of the pain, or presence of any correctable pathology.

Treatment:

Treatment modalities of Failed Back Syndrome varies greatly depending on the cause.

Surgical options:

  • If the cause of pain can be identified through diagnostic imaging, such as residual disc herniation, recurrent disc herniation or scar tissue formation, corrective surgery can be done to get rid of the causative pathology.

Injection Therapy:

  • Injections can vary greatly depending on the cause, such as trigger point injections, epidural steroid injections, or specialized injections for lysis of post surgical fibrous scar tissues, aka adhesions.

Advanced treatment:

  • In case of permanent damage to spinal nerves, where being a surgical candidate is not an option, spinal cord stimulation is one of the most successful procedures to help manage and control chronic pain in post laminectomy syndrome cases.