Post-laminectomy syndrome is a condition in which a patient continues to experience pain and disability after a laminectomy, a type of spinal surgery. During a laminectomy, a piece of the layer of bone covering the back of the spinal cord (the lamina) is removed to eliminate compression on the spinal nerves. This surgery may be performed in conjunction with other back surgery, such as a discectomy, and is most often performed to relieve stenosis, a narrowing of the spinal column. The development of post-laminectomy syndrome is a complication of the procedure. Post-laminectomy syndrome is a type of failed back surgery, a broader category which includes chronic pain following any spinal surgery, including spinal fusion.
Reasons For Post-Laminectomy Syndrome
In an interview on this topic, Dr. Srth Waldman from Hospital for Special Surgery gave a detailed answer:
This is not a simple question, because post-laminectomy syndrome is very complex even though it’s referred to as a single entity. Strictly speaking, post-laminectomy syndrome means that a person is experiencing pain, and that they had a prior spinal surgery (not necessarily even a laminectomy). As such, there are many different forms that this condition can take. Some possible variations include:
- The patient had spinal surgery, recovered well, and now has developed a new and unrelated spinal problem.
- The patient had spinal surgery, and despite the procedure going well, the original pain did not go away.
- The patient had spinal surgery, and developed a complication such as an infection, nerve injury, or failure to heal.
The problem becomes even more complicated when you consider the role that human behavior plays in the expression of pain. People express pain differently, and sometimes for different reasons at different times.
It is also important to consider the effect of the long-term use of narcotic pain medications in people with persistent pain, including post-laminectomy syndrome. Narcotic medications (opioids such as oxycodone or morphine) work by binding to the body’s natural endorphin system- the mechanism by which our brain interprets a sensation as painful or not. In fact, most prescribed opioids bind to the endorphin system so well that they crowd out our body’s naturally-produced endorphins, and inhibit the brain’s ability to produce these natural pain-relieving substances.
In the long term, this can lead not only to the development of tolerance to opioid medications, but an increase in the overall sense of pain. This paradoxical phenomenon is called opioid-induced hyperalgesia. When possible, patients and their doctors should moderate the use of pain medications due to the increased risk for developing increased pain with long-term use; and be careful of the serious short-term risk that these medications pose in terms of addiction, respiratory suppression, constipation, nausea, itching, etc.
Treatments For Post-Laminectomy Syndrome
There are a number of effective treatment methods used to address post-laminectomy syndrome. For patients experiencing severe symptoms, treatment may include:
- Nerve block injections
- Transcutaneous electrical nerve stimulation (TENS)
- Radiofrequency denervation
- Platelet rich plasma therapy
- Spinal Cord Stimulation
Milder cases of post-laminectomy syndrome may be treated successfully with anti-inflammatory medications, certain antidepressants, epidural corticosteroid injections, and physical therapy.