Post laminectomy syndrome, also known as failed back surgery syndrome (FBSS), is the recurrence or introduction of pain after any type of chronic pain surgery on the back and neck.
Although the term “post-laminectomy syndrome” implies that this pain only occurs after a laminectomy, the term is used interchangeably with FBSS to refer to any back or neck pain, of any kind, that is severe enough that the patient does not feel their quality of life has improved after undergoing surgery.
Post laminectomy syndrome can be distressing. But it is also treatable. Dr. James L Chappuis and his team at Spine Center Atlanta has worked with patients all over the United States to provide appropriate treatments for those with failed spine surgery, and we are available to help you improve your quality of life. For more information, please call us today at 404-341-4731.
What Is Post-Laminectomy Syndrome?
Aging, injury, and illness can all create chronic, severe, debilitating pain in the back, neck, and legs. This pain is often associated with the spine. Some of the most common conditions that lead to this pain include:
- Degenerative Disc Disease (DDD)
- Herniated Discs
- Spinal Stenosis
- Spine Cancers, and More
Sometimes this pain is manageable through the use of medications and physical therapy. But if the pain is too severe, doctors may recommend spine surgery. From laminectomies to spinal implants to discectomies to spinal fusions, there are many different techniques that orthopedic surgeons use to treat this type of chronic pain.
Most of these surgeries are successful. But some patients struggle with pain, even after they have recovered from the surgery. In some cases, the pain is mild enough to be manageable with non-surgical interventions. But in others, the pain is so severe, that the patient is struggling almost as much as before. When you still have severe pain after any type of spinal surgery, then the surgery is said to have failed, and is known as “post-laminectomy syndrome.”
Despite the terminology, post-laminectomy syndrome is not a specific syndrome. It is merely the recurrence of serious pain of any kind. Although most of the time the pain is directly related to the pain the patient experience pre-surgery, it is also possible for the pain to be new, a result of a change in the body after surgery is over.
Cervical And Lumbar Post-Laminectomy Syndrome
Because post-laminectomy syndrome may refer to a laminectomy (or other spinal procedure) nearly anywhere on the spine, it may occur anywhere on the neck and back. Surgeons generally look at where it occurs in order to determine the correct treatment:
- Cervical Post-Laminectomy Syndrome – When FBSS occurs in the neck (as well as the arms and shoulders), the surgery is usually due to an issue with the cervical part of the spine, which is the part of your spine from the back of the head down to just below the start of the shoulders.
- Lumbar Post-Laminectomy Syndrome – When FBSS occurs in the lumbar area of the spine (where most back surgeries are performed), this is known as “lumbar post-laminectomy syndrome.” Most lower back pain and leg pain is the result of the surgery in the lumbar area.
There is also thoracic post-laminectomy syndrome. The thoracic part of the spine is the middle of the spine between the neck and the lower back. Thoracic spine surgery is rare compared to the cervical and lumbar areas of the spine, and so failed thoracic spine surgery is equally rare. Nevertheless, it is conceivably possible to have recurring pain after thoracic surgery that may benefit from treatment.
Causes Of Post-Laminectomy Syndrome
Because post-laminectomy syndrome has a broad definition (any chronic pain in the back and neck after surgery), the causes can be equally broad. Some of the most common causes of post-laminectomy syndrome include:
- Surgical Error/Misdiagnosis – Surgery for chronic back and neck pain is easily some of the most delicate and complex medical procedures currently available, as well as one of the most difficult to diagnose. Thus, some surgeons make mistakes, both in their choice of treatment as well as their ability to successfully complete the procedure.
- Damaged Spinal Nerve Root – One possible causes of FBSS is the failure of the spinal nerve root to recover after surgery. After compression, the nerve roots are expected to recover. But in some cases, the damage may be too great, or the body may have a hard time restoring the nerve.
- Scar Formation – Another possible cause of post-laminectomy syndrome is the development of scar formation near the site of the surgery. If the scars develop near the nerves, the result may be the development of additional nerve pain.
- Disc Herniation – One of the most common causes of pain after laminectomy, and other spine surgeries, is disc herniation. Some techniques are specifically used on disc herniation, and are simply not successful. Others can weaken the muscles surrounding the discs, and unfortunately lead to the development of recurring disc herniation in the lumbar or cervical spine.
- Failed Fusion – In the case of spinal fusion, failed back surgery syndrome may be the result of bone grafts that did not fuse the vertebrae together correctly. This is known as a failed fusion, and usually results in the recurrence of pain.
- Hardware Failure – Many different types of spine surgery rely on hardware. Laminectomies are often partnered with other surgeries, like spinal fusion, that require the use of spine hardware. If this hardware is installed incorrectly, breaks, or is the wrong size, the person may experience post-laminectomy syndrome.
- Unknown Problems – There are several possibilities for why a person may have FBSS. Even a perfect surgery could still have residual pain. It is often important to seek out an expert in post-laminectomy syndrome treatments to better assess what solutions may be right to reduce pain in the future.
These are only a small fraction of the possible causes of both failed back surgery syndrome and post laminectomy syndrome. It requires a specialist in FBSS to correctly examine and diagnose what the cause of pain after laminectomy (and other back and neck surgeries) may have been.
There are also two issues that may cause the development of post-laminectomy syndrome that are worth highlighting, because they are also very common issues that affect FBSS development. These include:
- Lifestyle Habits – The number one preventable cause of post-laminectomy surgery is smoking. Smoking after surgery is a frequent reason that spinal fusion, and other spine surgeries fail, because smoking reduces circulation, and prevents bone and tissue regrowth. Obesity, failing to adhere to rehabilitation exercise guidelines, and uncontrolled diabetes can also contribute to FBSS.
- Diet – Poor diet can also make it difficult to recover properly from spine surgery. Your body needs a variety of nutrients to heal, including protein, calcium, and more. If it does not receive these nutrients, it may not heal correctly and the pain may return.
So while many different causes of post-laminectomy syndrome are related to the procedure, surgeon, and medical issue, there are also some causes that are directly related to the patient’s behavior and lifestyle after surgery.
Symptoms Of Post Laminectomy Syndrome
“Do you have pain or serious discomfort after you have recovered from any type of back or neck surgery?”
If the answer is yes, then you likely have post-laminectomy syndrome, or FBSS.
The pain may be the same pain that you experienced before surgery, or a new type of pain. It may be almost as severe or more severe. It may be radiating or centralized. It may have recurred right away, or developed over the course of a year.
Any and all chronic, distressing pain after spine surgery is considered to be post-laminectomy syndrome.
But our surgeons here at Spine Center Atlanta may look at specific symptoms as we determine the potential cause of your failed back surgery, and ultimately the type of treatment. Post-laminectomy symptoms include:
- Pain from Original Injury – One clear sign of failed back surgery is that the pain, tingling, and related symptoms that encouraged you to seek treatment return similar to the way they felt before. Often this means that the treatment itself was ineffective.
- Neuropathic Pain – Several issues can lead to what’s known as “neuropathic pain,” which is caused by injury to a nerve in the spinal cord. This may cause pain, as well as tingling and numbness, with locations that vary depending on which nerve is affected. The injury triggers the nerve to send pain information to other parts of the body.
- Chronic Radiculopathy – Similarly, one risk after back surgery is the development of a compressed or irritated nerve within the spine that does not go away. Symptoms depend on the location and the degree of compression, but may include pain, tingling, weakness, or numbness throughout the nerve.
- Pain at Surgery Site – Pain specifically in the location of the surgical site may also be a symptom of post-laminectomy syndrome. This may be due to surgical injury, infection, or hardware issues that cause localized pain.
- Altered Postures – Altered posture is one of the few non-pain related symptoms of FBSS. This occurs when the surgery itself altered the positioning of the back or neck. Altered posture itself can be problematic, but for many, the bigger concern is that altered posture may put stress on other areas of the spine, which may result in future injury.
It should be noted that post-laminectomy syndrome may also be due to the development of new spinal problems as a result of the surgery. For example, many Degenerative Disc Disease treatments can cause stress on other vertebrae, which may lead to faster breakdown and the development of new pain.
If some pain returns but the symptoms are easily manageable without medication or additional support, it may not necessarily be FBSS. But if the symptoms continue to reduce your quality of life, it is likely that you are suffering from post-laminectomy syndrome.
For those that believe they have post-laminectomy syndrome, the next step is diagnosis.
Diagnosis For Post-Laminectomy Syndrome
Once there are signs that the surgery has failed, proper diagnosis of the cause of the failure is key. Dr. Chappuis of Spine Center Atlanta, who is considered a nationally recognized expert in failed spine surgery treatment and revision surgeries, uses a variety of tools to determine the cause of your spine surgery failure. These tools are critical in order to make sure that any follow up treatments are effective.
Some of the tools used in diagnosis include:
- CT Scan
- Diagnostic Injections
- Surgical Consultation
Every diagnostic tool for FBSS that we use here at Spine Center Atlanta provides a detail that helps only those that are experts in failed surgery determine the possible causes. The more information that Dr. Chappuis and his staff have, the more they are able to better understand what treatments should be effective for treating the failed surgery.
Treatment for Post-Laminectomy Syndrome
For those that struggle with post-laminectomy syndrome, or those that believe they may have failed back surgery, treatment depends almost exclusively on the cause of the pain. Our first step will always be to look for potential non-invasive (non-surgical) treatments.
For pain that is not as severe, certain types of pain medication and injections may be enough to control it. Physical therapy may also be useful, especially if the cause of the pain is preventable and related to psychosocial factors, such as lifestyle. Possible non-surgical treatments include:
- Physical Therapy – In select cases, physical therapy under the guidance of those familiar with the causes of FBSS may be the right choice for treating the possible causes of post-laminectomy syndrome. Physical therapy is designed to help work on improving posture, rebuilding muscle around the surgical site, and more, all to minimize pressure and pain near the injury.
- Exercises – Exercise itself may be an important tool for recovery from post-laminectomy syndrome. Exercises that are designed around safely building your core muscles, including strengthening your back and the muscles around your spine, are often useful tools for eliminating or managing back pain.
- Aquatic Therapy – When the pressure on the spine is too severe for traditional exercises, or patients are not in the right physical condition for more intense exercises, aquatic therapy may be useful. Aquatic therapy helps hold up the body and significantly reduces pressure on the joints and muscles as they are strengthening.
- Massage/Acupuncture – Massage and acupuncture have a calming effect on the muscles and are believed to promote healing throughout the body. They are also safe and easy to implement, and worth considering for pain appears more muscle related and manageable.
- Medications – One of the most common treatments of post-laminectomy syndrome is the introduction of medications again. Sometimes, the initial treatment was successful enough to reduce pain, and – by reintroducing certain pain medications – the pain can be further managed until it is no longer affecting the patient’s quality of life.
- Diet – Post-laminectomy syndrome may simply be due to a slow recovery. If so, an improved diet, along with nutritional supplementation may be useful for speeding up recovery and preventing excess pain.
Although not all of these non-surgical treatments will prevent pain completely, some will help make pain far more manageable, and manageable pain is far less debilitating.
For more severe pain that is not easily managed through medications and non-surgical treatments, the next step is to simply try to find a solution that will genuinely solve the problem. Revision surgery may be necessary. But, when the cause of the FBSS is properly diagnosed, revision surgery has a high success rate.
The surgery may be the same surgery that you previously experienced, or it may be an entirely new technique. Diagnosis plays a key role. Possible surgical options include:
- Spinal Fusion
- Disc Replacement
With many different treatment options available, it helps to speak to surgeons that are specifically trained in diagnosing and resolving post-laminectomy syndrome. Dr. Chappuis and his team here at Spine Center Atlanta serve not only locals in Georgia, but also patients across the country that are seeking an expert in failed back surgery.
For more information about Spine Center Atlanta, or to schedule an appointment, please call our team today at 404-900-7690.