FAQs on Postlaminectomy Syndrome

Post-laminectomy syndrome refers to persistent disability and pain following back surgery. A laminectomy is performed to relieve nerve compression or nerve injury in the spine caused by spinal canal narrowing (stenosis) or disc herniation. These back conditions occur due to degenerative changes of the spine.

Why is a laminectomy performed?

The spine consists of several vertebrae separated by intervertebral discs, which are cushioning fibrous structures. These spine components are supported by muscles, ligaments, and tissues. The spinal cord runs between bony prominence of the vertebrae, and spinal nerves branch off this cord. When spinal stenosis or a herniated disc occurs, it causes pressure on the spinal cord and/or spinal nerve roots. A laminectomy involves removing a section of the lamina (bony arch), which forms the posterior region of the spinal canal. This alleviates impingement on the nerves.

What are the symptoms of post-laminectomy syndrome?

Also called failed back surgery syndrome (FBSS), post-laminectomy syndrome refers to pain associated with symptoms not relieved following surgery. These symptoms vary from patient-to-patient, but include:

  • Persistent back pain of varying qualities
  • Leg numbness, tingling, weakness, and/or pain
  • Back stiffness and limited range of motion

Who gets post-laminectomy syndrome?

The risks for poor surgical outcome following a laminectomy include:

  • Surgery on people who are poor candidates
  • History of previous unsuccessful surgery
  • Pre-existing documented history of clinical depression
  • Severe pain before surgery
  • Existence of severe spinal conditions, such as degenerative disc disease, spinal stenosis, spondylolisthesis, and spinal arthritis
  • Localized tenderness
  • Generalized discomfort

How is post-laminectomy syndrome diagnosed?

The doctor will take a medical history to evaluate your condition. The medical history of people with post-laminectomy syndrome varies from person-to-person. A physical examination is performed to evaluate gait, range of motion, posture, spinal symmetry, spinal curvature, and deformities. Testing involves x-rays, magnetic resonance imaging (MRI), computed tomography (CT), bone scans, nerve conduction studies, and electromyography.

What are the treatment options for post-laminectomy syndrome?

Treatment options include:

  • Epidural steroid injection (ESI) – Usually given in a series of three, ESI involves administering an injection of a corticosteroid into the space around the spinal cord (epidural space). A long-acting anesthetic is sometimes added to potentiate effects. ESI offers long-term pain relief, as it targets the affected nerves. According to research studies, this procedure has an 80-90% success rate.
  • Facet joint injection – The facet joints are tiny joints along to posterior aspect of the spinal column. The doctor can inject the nerves and joint to reduce inflammation and pain. This offers long-term relief when spinal arthritis occurs along with FBSS.
  • Selective nerve root block – A selective nerve root block involves targeting the selected nerves that cause pain. A single long-acting anesthetic is injected onto the nerve roots. To effectively block affected nerves, radiofrequency energy is applied to the targeted sites. Based on recent studies, this procedure has an 87% success rate.
  • Intrathecal pump implant – For severe pain, a pain pump can be surgically implanted. The device is placed under the skin of the lower abdomen and buttocks, and a catheter runs from the unit to the spinal cord region. The medication bypasses the gastrointestinal tract.
  • Electrical stimulation – Called neuromodulation, a spinal cord stimulator (SCS) can be implanted into the body. Electrodes near the spinal cord transmit mild electric current that interferes with pain signal transmission.

Resources

Botwin KP, Gruber RD, Bouchlas CG, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study. Am J Phys Med Rehabil. 2002 Dec. 81(12):898-905.

Narouze SN, Vydyanathan A, Kapural L, et al. Ultrasound-guided cervical selective nerve root block: A fluoroscopy-controlled feasibility study. Reg Anesth Pain Med. 2009;34(4):343-348.

Riew KD, Yin Y, Gilula L, et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000 Nov. 82-A(11):1589-93.

Son JH, Kim SD, Kim SH, et al. (2010). The Efficacy of Repeated Radiofrequency Medial Branch Neurotomy for Lumbar Facet Syndrome. Journal of Korean Neurosurg Soc, 48(3), 240-243.

Vad VB, Bhat AL, Lutz GE, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study. Spine. 2002 Jan 1. 27(1):11-6.