Post-laminectomy syndrome (PLS) is a chronic, painful disorder that occurs after someone undergoes back surgery, particularly a laminectomy. Also called failed back surgery syndrome (FBSS), PLS is a general term to describe many symptoms patients experience after the back procedure(s).
What structures are affected by post-laminectomy syndrome?
The spine is composed of 24 irregular-shaped bones stacked upon one another from the base of the skull to the pelvis. These bones protect the spinal cord and associated spinal nerve roots that branch from the cord. Each vertebra has an opening in its center that creates the spinal canal, which houses the spinal cord. The lamina is a part of the vertebra that connects the bony spinous process to the main body of the bone. During a laminectomy, the lamina is removed along with bone spurs, which is done to relieve pressure on spinal nerves.
What causes post-laminectomy syndrome?
There is no one exact cause of failed back surgery syndrome. Rather, PLS is caused from a combination of factors. Experts have several theories of the cause of post-laminectomy syndrome. These include:
- Epidural fibrosis – Where scar tissue develops during the post-operative healing process, and the tissue compresses nearby nerve roots causing much pain.
- Error in surgery – Surgical intervention at the wrong spinal level, as well as incomplete removal of the lamina.
- Inflammation – Involves arachnoiditis and inflammation within the protective layers of the spinal cord.
- Psychosocial issues – Problems such as depression and anxiety that interfere with recovery.
What symptoms are associated with failed back surgery syndrome?
Post-laminectomy syndrome involves persistent back pain that can be aching, stabbing, pounding, throbbing, or burning. Other symptoms include leg tingling, numbness, weakness, and/or stiffness. In addition, the patient may have limited range of motion of the spine as well as spinal stiffness.
Who is at risk for post-laminectomy syndrome?
Many people who have back surgery do fine, and do not develop chronic pain. However, certain people are at higher risk for developing PLS. Risk factors include:
- Severe pain before the surgery.
- History of previous unsuccessful surgery.
- Being a poor candidate for surgery.
- Pre-existing documented history of clinical depression
- Certain spinal conditions (degenerative disc disease, spinal arthritis, spinal stenosis, and spondylolisthesis).
How is post-laminectomy syndrome diagnosed?
The doctor may recognize a developing pattern of chronic pain after surgery, along with poor post-surgery outcomes. FBSS is a diagnosis made based on patient symptoms and recurrent, chronic pain. The doctor will order laboratory and diagnostic imaging tests to identify structural abnormalities, scarring, and possible inflammation.
How is post-laminectomy syndrome treated?
Treatment of PLS depends on the symptoms, so it is situation-dependent. Therapy is tailored to each patient’s unique problem. Treatment options include:
- Medications – To relieve pain, drug options include anticonvulsants, tricyclic antidepressants, opioid pain relievers, and anti-inflammatory agents.
- Adhesiolysis – This involves removal of fibrotic scar tissue. The doctor uses special instruments, a laser, or chemical agents to remove scar tissue.
- Epidural steroid injection (ESI) – This involves injecting a corticosteroid, with or without an anesthetic agent, into the space around the spinal cord. ESIs are often given in a series of three, and offer long-term pain relief by decreasing nerve irritation and inflammation. According to medical reports, ESI has an 85-90% efficacy rate.
- Spinal cord stimulation (SCS) – A small device is surgically implanted in the buttock or lower abdomen. Wires run from the device and attach to surgically placed electrodes near the spinal cord. The device emits mild electric current that interferes with pain conduction pathways and stimulates the release of endorphins (natural pain killers).
- Facet joint injections (FJIs) – On both sides of the posterior spinal vertebra are two tiny facet joints. The doctor can inject several of these joints with a corticosteroid and/or long-acting anesthetic. Sometimes, a neurolytic agent (phenol or absolute alcohol) is added to destroy a portion of the nerve root. In several randomized controlled trials involving FJIs for chronic back pain related to the facet joints, this procedure had an 83% success rate, with significant functional improvement and pain relief after injections.
- Selective nerve root block – Targeting the affected nerve root, this involves use of radiofrequency energy to deaden the nerve to offer long-term pain relief. X-ray guidance (fluoroscopy) is used to assure correct placement of the needle and probe. Based on current clinical studies, this procedure offers an 87% efficacy rate.
- Intrathecal pump implant – For severe back pain, the doctor can surgically implant a small pump in the body. The device has a catheter that inserts directly into the epidural space to deliver medication
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