Post-laminectomy syndrome describes persistent back pain occurring after any back surgery but is most commonly associated with a laminectomy.
During this procedure, a surgeon removes a portion of the vertebral bone to relieve pressure placed on the spinal cord by a protruding disc. This condition is sometimes referred to as failed back surgery syndrome. There are several ways this condition occurs:
- Following successful back surgery, someone develops a new and unrelated spinal problem.
- The original pain persists following a back surgery because the surgery failed to achieve the desired outcome or because the surgery was unnecessary.
- Following spinal surgery, complications such as an infection or nerve injury occur.
Lumbar post-laminectomy syndrome refers to pain felt in the lumbar, or lower, part of the spine. Post-laminectomy syndrome can also affect the cervical, or upper portion of the spine, and the thoracic, or middle, part of the spine. Thoracic post-laminectomy syndrome is rare. This condition is not yet fully understood, but researchers continue to study it. One current prominent theory among researchers is that this condition is caused by scar tissue development that causes pain by compressing nearby nerve roots.
While another back surgery is a treatment option, medical professionals tend to treat lumbar post-laminectomy syndrome with at least one of the following treatment options before performing another surgery:
- Medication: over-the-counter pain relievers and NSAIDs, high doses of prescription morphine-based painkillers
- Physical therapy
- Routine stretches, functional mobility training, and yoga
- Electrical stimulation
- Epidural nerve blocks
- Radiofrequency denervation
- Facet joint injections
- Spinal cord stimulation
One of the most common symptoms of lumbar post-laminectomy syndrome is lower back pain – especially at the surgery site.
Leg pain typically accompanies lumbar pain, and neurologic symptoms, such as temperature changes, feelings of heaviness, and loss of strength, may occur in your arms or legs. The surgery site may remain tender to the touch, and you may experience difficulties when performing daily activities or sleeping. Some may alter their posture and vary their gait when walking to compensate for lower back pain.
One of the first questions your doctor will ask is your most recent back surgery date, so ensure you record the dates of any back surgeries as you track your symptoms after the surgery. Your surgeon performing the surgery will inform you how long until you feel pain relief following the operation. Knowing that expected timeline can help you determine when to see a doctor about post-laminectomy syndrome.
Proper diagnosis is important for this condition, so your doctor may order any of the following diagnostic tests to eliminate any other possible causes of lower back pain:
- Blood tests
- Imaging tests: x-ray, CT scan, or MRI
- These tests allow doctors to inspect any residual compression on your spinal nerves following your surgery.
Your physician may refer you to a specialist for further testing and diagnosis.
There are many potential causes for lingering back pain following back surgery.
- The performed back surgery may not have been medically necessary or was treating the wrong condition.
- Damaged spinal nerve root
- Scar formation
- Herniated disk
- Spinal stenosis occurring after back surgery
- Failed fusion or hardware: When a spinal fusion is performed incorrectly, the bone grafts may not correctly fuse the vertebrae together. Many other types of back surgeries require some form of hardware or equipment that possesses the potential to malfunction or break during or after the surgery.
There are two risk factors that increase your likelihood of developing post-laminectomy syndrome: smoking and previous history of failed back surgeries.
US surgeons conduct about 500,000 spinal surgeries per year with approximately one-fifth (20%) of back surgeon patients living with some form of residual back pain after their surgery.