Conditions

Post-laminectomy Syndrome

What is post-laminectomy syndrome?

Post-laminectomy syndrome (PLS), also known as failed back syndrome, describes a chronic, painful condition that some patients develop after undergoing back surgery, specifically a laminectomy. Post-laminectomy syndrome is not a diagnosis, but rather a general term to describe a variety of chronic pain syndromes experienced by patients as they emerge from back surgery.

What causes post-laminectomy syndrome?

The exact cause of post-laminectomy syndrome is unknown; however, one prominent theory points to epidural fibrosis, in which the development of scar tissue during post-surgical healing compresses nearby nerve roots and causes pain. Other possible causes include:

  • Surgical intervention at the wrong spinal level
  • Incomplete removal of the lamina
  • Arachnoiditis, or inflammation within the protective layers of the spinal cord
  • Psychosocial problems, such as depression, interfering with recovery

Typical diagnosis
Diagnosis of post-laminectomy syndrome is made following surgery as a doctor recognizes a developing pattern of chronic pain and poorer post-surgical outcomes than expected. A physician may order laboratory or imaging studies to identify possible inflammation or other structural abnormalities where the lamina was removed. The physician may also perform a mental health screening to rule out any psychosocial causes.

Symptoms

As with most back pain, the type of pain can either be muscular or nerve-related. Muscular pain (or tenderness) is often a short term source of pain following back surgery.

Nerve pain, however, is the most common reported symptom of failed back or neck syndrome. You may experience shooting pain, tingling, or weakness in the extremity impacted by the back surgery. You may also find that some of the nerves around the surgical site are painful and causing localized numbness. Common symptoms include:

  • Similar pain you experienced prior to surgery
  • Dull and achy pain in or around the spinal column
  • Sharp, pricking, and stabbing pain
  • Leg pain

Treatments (cont.)

Spinal cord stimulation
Spinal cord stimulation via placement of electrodes into the epidural space of the spinal cord thought to be associated with the pain may be appropriate for some patients. The electrodes apply an electric current to interfere with pain conduction pathways. While the outcomes of spinal cord stimulation can be good, there is a high rate of complications associated with electrode implantation.

Adhesiolysis
Adhesiolysis or the disconnection of fibrotic scar tissue after surgery may also be an option. During adhesiolysis, the scar tissue can be mechanically removed with special instruments or chemically removed via injection of saline or other solutions. Post-laminectomy syndrome can affect patients long-term and significantly affect an individual’s lifestyle and ability to return to work. With proper treatment, however, pain can often be reasonably managed.

Procedures / Surgeries

Treatment options are situation-dependent and must be tailored to each patient individually. Some of the possible treatment options include:

Medications

Opioids can be used for pain management, however, responses are unpredictable. The side effects of long-term opioid use can be serious, and long-term outcomes aren’t well understood.

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