What is Post-laminectomy Syndrome?
Post-laminectomy syndrome is persistent pain after lumbar surgery
associated with laminectomies but sometimes this diagnosis will be given
even if a laminectomy has not been performed. Post-Laminectomy Syndrome is
synonymous with failed-back surgery syndrome.
Laminectomies are surgical procedures of the spine. They are typically
done in the lumbar spine but can also be done in the cervical spine. Bone
is removed (the lamina) to relief pressure of off a nerve root or the
spinal cord. Intractable pain and weakness are usually the indications for
the procedure. Most of the time patients do great after the procedure but
there are times where patients can have persistent pain after.
Post-laminectomy Syndrome Etiology?
Lack of relief after a laminectomies can be due to a multitude of
problems. Misdiagnosis, complications by nerve root injury, or just
general patient expectations can be pitfalls to lack of pain relief after
surgery. Scar tissue can also form around the nerve root after a
laminectomy as well.
Symptoms and Diagnosis
Pain at the site of surgery accompanied by leg pain can be the presenting
symptoms. Follow up with CT or MRI's can r/o persistent nerve root
compression.
How is Post-laminectomy Syndrome treated?
Treatment options depend on the severity of the presenting symptoms along
with time since surgery.
*The most important part of treatment is having a firm diagnosis of the
current problem. This means a thorough physical exam and history must be
done. Finding a well-rounded and thorough pain specialist is very
important so that you are not misdiagnosed.
*Medications can be used for mild to moderate pain. Medications
include antineuropathics like gabapentin, lyrica, tramadol, amitriptyline,
etc. (there are others not mentioned here). Mild, as needed, opioids can
be used as well.
*Physical therapy can be used for mild to moderate pain as well.
*Moderate to severe pain can be treated with injections, ketamine
infusions, and spinal cord stimulation.
