Approximately 500,000 back surgeries are performed in the United States every year, but not all of them turn out successful. What happens when the operation that was meant to relieve your back pain fails after you’ve recovered? This is called Post Laminectomy Syndrome, otherwise known as failed back surgery syndrome.
What is Post Laminectomy Syndrome?
A laminectomy is usually performed for a person who has been dealing with chronic back or leg pain and conventional treatments such as medication and physical therapy have not alleviated symptoms. While most back surgeries will be successful about 20% of patients in the United States will continue to have persistent back and leg pain after the surgery. Some post-surgical pain is normal following any operation but if it lasts longer than the prescribed time of recovery there’s a possibility of Post Laminectomy Syndrome.
Post Laminectomy Syndrome is a generalized way of describing situations where the desired results are not seen following the operation. It is also known as failed back syndrome or failed back surgery syndrome. This term is used to describe the condition created when spine surgery does not correct the issues the patient underwent the surgery to correct or creates more issues in addition to the original complaint. Back, neck and leg pain may worsen leading to disability.
Correctly diagnosing Post Laminectomy Syndrome is difficult at times. In some cases it may turn out that the reason the surgery failed is because the issue the surgery was to correct is not the source of the patient’s back pain. Some open back surgeries have a higher chance of causing failed back surgery syndrome and it may be possible to predict before the operation if it will be successful. Discussing these options and possibilities with your doctor may prevent chronic back pain from developing.
What are the Causes and Risk Factors?
There are a range of issues that lead to back pain after spine surgery and being able to accurately determine the cause helps with future treatment. Frequent cause of post laminectomy syndrome include:
- Misdiagnosis of the original cause of back pain. If this is the case then surgery would not address the cause of your pain.
- Nerve root compression.
- Recurrence of disc herniation.
- The formation of scar tissue around a nerve.
- Failure from spinal fusion surgery.
Age and weight also come into play as possible causes of failed back syndrome due to the weakening of bones and spinal tissue and the excess weight on the skeletal system. Sports participation is also a risk factor as re-injury is increased post-surgery.
Smoking also has a part to play in the occurrence of failed back surgery syndrome making the body’s healing process more difficult and affecting bone growth and tissue regeneration. Those who smoke are at a much higher risk for post laminectomy syndrome following open back surgery. Nicotine has a particularly detrimental effect on spinal fusion surgeries leading to operation failures with such issues as increased scar tissue build-up and interference with bone metabolism (which is necessary for a successful fusion as the bones grow together.) Quitting smoking also contributes to making healthy lifestyle choices and helps with weight loss. It is recommended that anyone considering major spine surgery to relieve their back pain who also smokes seek a physician’s help with smoking cessation.
What are the Symptoms?
Following any surgery it is normal to expect pain in the area where the operation is formed. Since many patients expect this after spine surgery it may be difficult to determine whether or not your pain is from the body healing or a sign of a serious complication. Before operation your doctor will tell you what you can expect after the surgery and how long it typically lasts. Anything that is different from what your doctor describes may be a sign of failed back syndrome. If you are experiencing pain after back surgery contact your doctor to determine if it is from a post laminectomy syndrome or another issue that needs attention.
The following symptoms are categorized as signs of possible failed back surgery syndrome.
- Continuing pain around the area the operation was performed on.
- New pain, either cervical, thoracic, or lumbar area pain.
- Returning symptoms like those before surgery.
- Cervical or lumbar cramps or spasms.
- Numbness or tingling in the back, neck, shoulders, arms and legs.
- Worsening of back pain prior to surgery.
If you experience any of these symptoms or others following spine surgery contact your doctor as soon as possible to determine if the surgery address the correct cause of back pain. Normal Post-surgical pain can be managed with medication or physical therapy. However if this does not relieve the pain your doctor can take steps to determine why the pain still persists and what steps to take to properly treat it.
How is Post Laminectomy Syndrome Treated?
The first step in treating post laminectomy syndrome is a correct diagnosis. Being able to treat the real cause of back pain is the best course of action in any situation. Once you know why your back pain persists and what caused the surgery to fail you can take steps towards treating and managing the pain.
- Non-invasive methods of pain treatment include physical therapy and stretching. Exercise and weight management may also be recommended as ways to increase muscle strength and reduce strain on the spine.
- Medications to help manage the pain of failed back syndrome include non-steroidal anti-inflammatory drugs such as aspirin, naproxen or ibuprofen. These medicines may be used in conjunction with physical therapy.
- Hot or cold compresses can be used with the above treatments to provide temporary relief.
- Therapy may be recommended for patients who deal with stress to help them deal with their pain while they recover.
If you continue to have chronic back pain with no relief then a doctor may recommend an epidural steroid injection as an alternative to further surgeries. An epidural steroid injection allows medicine to directly target the area around an inflamed or irritated spinal nerve and give long-lasting although temporary pain relief. While initial results of an epidural steroid injection may prove helpful your doctor may limit future doses as the medicine loses its effectiveness over time. There are also several less-desirable side-effects such as nausea, headaches, muscle weakness and weight gain.
While spine surgery may be the answer to your back pain it is not without its risks. Discuss any concerns about failed back surgery syndrome with your doctor who can recommend steps to take to increase the chances of a successful surgery.