A laminectomy is a surgical procedure in which part or all of the vertebral bone (lamina) is removed to reduce pressure on the nerve roots in the spinal cord. This procedure is done to treat back problems such as spinal stenosis and herniated discs. In most cases, the surgery is successful and patients recover without any complications. However, a minority of patients report ongoing, even debilitating back pain following laminectomy. This persistent or chronic pain is known as post-laminectomy syndrome or failed back surgery syndrome (FBSS).
Exactly why some patients pull out of back surgery “with flying colors” and others do not is unknown. Researchers have been unable to pinpoint any definite cause or causes of post-laminectomy syndrome. However, there are a number of very plausible explanations.
Many researchers believe that the scar tissue that forms in the spine following surgery may surround and compress the nerve roots, which gives rise to chronic pain. Or, there could be small fragments of the intervertebral discs still remaining after the surgery, which could irritate the nerves in the spine and cause pain. Other possible causes include post-operative spinal or pelvic ligament instability (such as sacroiliac joint dysfunction and myofascial pain), unforeseen structural changes in the spine that develop post-surgery either above or below the surgical site, or a new or returning disc herniation.
Some patients may be predisposed to the development of post-surgical back pain due to systemic disorders such as diabetes, autoimmune disease, peripheral blood vessels (vascular) disease, and mental health issues such as anxiety and depression. Some evidence suggests that tobacco smokers are more likely than non-smokers to develop post-laminectomy syndrome following surgery to the back.
The most common symptoms of post-laminectomy syndrome are persistent lower back pain (particularly at the site of surgery), along with neck or leg pain. Because of the pain they are experiencing, patients often have difficulty performing their responsibilities necessary for day-to-day living (at work, school, etc.) and may have trouble sleeping as well. The longer the pain persists, the greater the impact it can have on the patient’s life. Some patients become so discouraged about their failed surgical results and how the pain is impacting their lives that they go into severe depression or even have anxiety attacks.
As with any painful condition, the most effective treatment is based upon an accurate diagnosis of the underlying problem. When patients come to Advanced Pain Consultants for care, Dr. Sonia Pasi utilizes state-of-the-art diagnostic techniques to help pinpoint the cause of pain.
To make a preliminary diagnosis of post-laminectomy syndrome, Dr. Pasi will gather information about the patient’s medical history and conduct a physical examination. She will look for particular signs in the patient, such as tenderness at the site of surgery, altered postures when sitting, and an abnormal gait when walking. When Dr. Pasi is done with the exam, she will normally be able to make a preliminary diagnosis.
To further confirm the diagnosis, Dr. Pasi may order radiologic studies such as x-rays, magnetic resonance imaging (MRI) scans, and computed tomography (CT) scans to examine the internal structures of the spinal cord. These tests will reveal any bone fragments that may be remaining or if there is spinal cord compression, both of which could irritate the nerves in the spine and cause significant pain. Once she knows exactly what is going on, Dr. Pasi works with each patient she sees to develop an effective and customized treatment plan.
A number of effective treatment methods are available to address post-laminectomy syndrome. For the first-line of treatments Dr. Pasi will usually recommend physical therapy and exercises to strengthen the muscle groups in the abdomen, lower back and legs.
Pain medications may also be prescribed to help manage the pain. Oral steroids, such as cortisone and prednisone, can reduce both inflammation and pain. Certain antidepressant medications may also be utilized, which can provide pain relief in addition to their antidepressant effects. In some cases, opiods (narcotics) may be administered for pain control, but only in very limited situations as this option may impact the daily functioning of the patient. For those with mild to moderate pain, non-steroidal anti-inflammatory medications (available over-the-counter) may provide just enough pain relief.
For patients who suffer from severe or chronic pain, Dr. Pasi may recommend more intensive treatments such as epidural nerve blocks (which involves the injection of steroids into the epidural space in the spine to relieve pain caused by inflamed nerve roots), transcutaneous electrical nerve stimulation therapy (low-voltage currents are delivered to the affected tissues to decrease pain), radiofrequency facet denervation (heat is generated by radio waves to disable nerves from transmitting pain signals), and spinal cord stimulation (electrical impulses are emitted near the spine to control pain signal transmission, thereby reducing pain). Each of these treatments are minimally invasive, can be performed on an out-patient basis, and are quite effective at minimizing pain.
Living with post-laminectomy syndrome can be a daily struggle, and interfere with your daily activities. It can be difficult to walk, sit, bend over or even sleep comfortably. If your back problems have you feeling miserable and they aren’t getting any better, it’s time to seek medical attention.
At Advanced Pain Consultants, our goal is to relieve your pain and improve your quality of life as quickly, efficiently and non-invasively as possible. Please call our office today at (919) 510-7901 to schedule an appointment with Dr. Pasi. During your consultation, she will evaluate your unique situation and develop an individualized treatment plan that is tailored for you. Stop letting back pain ruin your life. Request your appointment today.