Post Laminectomy Syndrome

What is Post Laminectomy Syndrome?

Post-Laminectomy Syndrome is also known as failed back surgery syndrome (FBSS) which is a term to describe patients who have had continued pain after back or spine surgery. Despite its name, post-laminectomy (or FBSS) does not mean that you or your surgeon have failed, but rather factor out of either of your control are causing you to have continued back or neck pain. Even with the best surgeon and surgery for the best indications, spine surgery is no more than 95% predictive of a successful result – meaning there is always a chance your pain can return or stay the same.

Your pain or other symptoms can return immediately or even months after your surgery. Besides continued back or neck pain, you may experience other symptoms such as neurological and extremity (arm or leg) radicular pain. These symptoms can continue to impact your quality of life and functional ability.

Though difficult to measure, studies have shown that FBSS occurs in 10%-40% of patients depending on the type of spinal surgery performed, resulting in a significant amount of disability and pain.

With each spine surgery you have after developing FBSS, the chance of success drops:

  • 50% success rate after the first repeat surgery

  • 30% success rate after the second

  • 15% success rate after the third

  • 5% success rate after the fourth

 



What Are The Symptoms?

Post-laminectomy (FBSS) symptoms vary by patient, but typically neck or back (spine) pain occurs or returns after surgery. Other symptoms of post-laminectomy syndrome can include neurological problems, such as weakness, numbness, tingling, pins/needles sensations. You can also develop or have recurrence of arm or leg radicular pain.

Diagnosis

Your pain management specialist will perform a thorough history and physical examination as this is very important to determine if your current symptoms are related to your surgery, or if the pain is from something new that you developed over time. Your doctor may also order imaging or other tests to help assess a cause of your pain which may include:

  • X-ray

  • MRI

  • CT Reconstruction

  • CT Myelogram

  • Discography

  • Diagnostic injections

What Are The Treatments?

Treatment for post-laminectomy syndrome (FBSS) is a multidisciplinary approach and dependent on the source of your pain. After spine surgery, the muscles, discs, bones or nerves can cause you to have pain, and so treatments will need to target whichever of those may be causing your pain.

Medications

Multimodal medication treatment can help target multiple receptors and provide better pain control than a single medication. Examples of medications can include, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, muscle relaxants, antidepressants, anticonvulsants, and opioid medications.

Therapy

Physical therapy is an important tool for helping improve strength and flexibility of the spine where you had surgery. This can also help allow you to continue functioning and doing activities you once performed.

Pain psychologists can play a vital role in your treatment for post-laminectomy (FBSS). Pain psychologists are specially trained in helping patients learn different techniques to deal with their pain. These techniques can include biofeedback, mindfulness, and many others.

Injections

Epidural steroid injections. These can help if nerves are being irritated or compressed as they exit the spine.

Trigger point injections. Muscles can be affected after certain spinal surgeries and become tight, painful knots (“trigger points”) which may improve after injecting medication and dry needling.

Minimally Invasive Surgery

Spinal cord stimulation. This treatment has been shown to provide patients significant relief, quality of life and ability to maintain function.

Intrathecal drug delivery system. Patients who may not respond to spinal cord stimulation still have hope of living a high quality of life with intrathecal drug delivery system placement. Some patients prefer these systems over spinal cord stimulation, or having both in place.

Surgery

Sometimes patients require a repeat surgery if their pain fails to improve or worsens after their initial surgery. This can be due to various reasons, but your pain management specialist will ensure you have appropriate referrals to trusted surgeons if it is recommended you be seen by one.