Post-Laminectomy Syndrome
Laminectomy is a type of spinal decompression surgery that’s widely used to treat spinal stenosis, herniated discs, spinal stenosis, and spinal nerve impingement. By removing some or all of the lamina – the piece of bone enclosing the back of the spinal canal – surgeons can create more room in the spinal canal and decompress impinged nerves.
But, what happens when a laminectomy goes wrong? Although laminectomy has a high success rate, it causes a condition known as post-laminectomy syndrome in some patients.
Read on for a comprehensive overview of post-laminectomy syndrome, its symptoms, and whether or not it can be cured.
Table of Contents
- Can a Laminectomy Go Wrong?
- Does Lamina Grow Back After Laminectomy?
- What Are the Long-Term Problems After a Laminectomy?
- Can Post-Laminectomy Syndrome Be Cured?
Can a Laminectomy Go Wrong?
A laminectomy can go wrong, although severe complications are rare.
Ways in which a laminectomy can go wrong include:
Surgical Complications
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Certain complications can occur with any surgical procedure, including bleeding, blood clots, infection, and reactions to anesthesia. These complications are relatively rare, but your risk may be elevated if you’re over age 65, have underlying medical conditions, smoke, or are obese.
Your surgeon will evaluate your risk of developing these complications while determining whether laminectomy is right for you. Certain lifestyle choices, like quitting smoking, eating healthily, avoiding alcohol, and staying active can also reduce your risk of surgical complications.
Nerve Damage
Laminectomy involves the spinal area, and the surgeon must work close to the spinal cord, adjacent nerves, and dura (the spinal cord’s protective covering). This creates the risk of nerve damage. However, nerve damage is a rare complication of laminectomy, affecting 0% to 2% of patients.
Recurring Pain
Pain that returns after surgery is the most common way in which a laminectomy can go wrong. Also known as failed back surgery syndrome (FBSS) or post-laminectomy syndrome (PLS), recurring back pain after laminectomy may result from:
- Scar tissue formation
- Damage to surrounding muscle, ligament, or nerve tissue during the procedure
- Degeneration in the surrounding spinal segments
- Fusion failure, if laminectomy is performed with spinal fusion
- Hardware failure, with which the screws, rods, and plates used to stabilize the spine fail over time
Often, the exact cause of recurring pain after laminectomy is unknown.
Does Lamina Grow Back After Laminectomy?
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The lamina can partially grow back after laminectomy, but full regrowth doesn’t occur.
Research published in 2019 shows that bone regrowth has been reported in up to 94% of people who underwent laminectomy or laminotomy. The highest rate of regrowth appears at the L3-L4 spinal level and in cases of laminectomy with spinal fusion.
Bone regrowth after laminectomy doesn’t always cause problems or recurring pain. However, in some patients, the redeveloped bone causes the spinal stenosis and/or nerve impingement to return.
What Are the Long-Term Problems After a Laminectomy?
Long-term problems after a laminectomy can include post-laminectomy syndrome, returning lumbar spinal stenosis, pain from scar tissue, and adjacent segment degeneration.
What Exactly is Post-Laminectomy Syndrome?
Post-laminectomy syndrome is the term used to describe back and leg pain after laminectomy. Also known as failed back surgery syndrome, this condition causes recurring or even worsening pain after the procedure.
An estimated 8% to 40% of adults who have lumbar spine surgery, including laminectomy, experience chronic or returning back and leg pain after the procedure.
Returning Spinal Stenosis After Laminectomy
Spinal stenosis, which occurs when the spinal canal narrows and potentially impinges on nearby nerves, can return after laminectomy. This problem can arise if bone tissue regrows at the spinal level that was operated on. This tissue can take up space in the canal, causing symptoms of spinal stenosis like back pain, numbness, tingling, and weakness.
Recurrent spinal stenosis can also result from ongoing spinal degeneration after the procedure. Degenerative spinal stenosis is often caused by herniated discs, bone spurs, and thickening spinal ligaments – all common age-related spinal changes.
Scar Tissue From Laminectomy
Scar tissue is a type of fibrous tissue that forms as a response to tissue damage, including the incisions that occur in surgery. It’s a normal part of your body’s healing process and helps replace the damaged tissue. However, scar tissue can also cause pain after spinal surgery and is a prevalent cause of failed back surgery syndrome.
In some cases, scar tissue forms around the spinal cord or nerves. This is known as epidural fibrosis. The scar tissue can press on the spinal nerves, leading to back pain and neurological symptoms.
Adjacent Segment Degeneration
Adjacent segment disease, or ASD, is a possible complication of laminectomy with spinal fusion. When two or more vertebrae are fused, it forces the adjacent segments to bear more impact throughout the day. This can cause the adjacent vertebrae and intervertebral discs to gradually break down, causing back pain and other symptoms.
Some patients who develop adjacent segment disease require reoperation. However, it may be managed with conservative methods, like physical therapy and pain medications, in some cases.
What Are the Symptoms of Post-Laminectomy Syndrome?
The symptoms of post-laminectomy syndrome are back pain, stiffness, numbness, weakness, and tingling. These symptoms may radiate from the back to the lower extremities.
With post-laminectomy syndrome, your pain may feel similar or different from the pain you experienced before the laminectomy. It may feel like:
- A dull ache in the back, along the spine
- A sharp or stabbing pain in the back or legs
- A prickling or “pins and needles” sensation in the back or legs
What Causes Post-Laminectomy Syndrome?
As we mentioned in a previous section, the exact cause of post-laminectomy syndrome isn’t always clear. However, some common causes include scar tissue formation, returning spinal stenosis, herniated discs, surgical complications, and adjacent segment disease.
Post-laminectomy syndrome can also develop if the true cause of your initial symptoms isn’t properly addressed in the procedure. For example, this condition can occur if the impinged nerve isn’t fully decompressed, or a pinched nerve in a neighboring segment isn’t treated.
Can Post-Laminectomy Syndrome Be Cured?
Post-laminectomy syndrome can be cured in many cases with conservative treatments, although corrective surgery is necessary in severe cases.
Treatment options for post-laminectomy syndrome include:
Physical Therapy
Physical therapy for post-laminectomy syndrome generally includes targeted exercises to strengthen the core and abdominal muscles, along with stretches to reduce muscle tension. Your PT can also provide a personalized exercise plan and complementary therapies (like massage, acupuncture, and electrostimulation) to support your recovery.
Medications
Medications, including NSAIDs and other types of painkillers, may help you manage the symptoms of post-laminectomy syndrome. Your doctor can provide individualized suggestions based on your symptoms, medical history, and risk of side effects.
Epidural Steroid Injections and Nerve Blocks
Epidural steroid injections and nerve blocks involve administering steroid medication directly to the affected area of the spine. By dampening the immune response to the injury, these injections may offer temporary pain relief.
Spinal Cord Stimulation
Spinal cord stimulators are specialized devices that are implanted into the body. It delivers low-level electrical pulses straight to the spinal cord, providing pain relief. This treatment is commonly implemented for cases of failed back surgery syndrome that don’t respond to physical therapy or medications.
Radiofrequency Ablation
Radiofrequency ablation delivers radiofrequency waves to the affected area of the body. These waves heat the targeted nerve tissue, thus destroying the nerve and blocking its pain signals. As a minimally invasive procedure, this procedure is often considered before reoperation for post-laminectomy syndrome.
Reoperation
Reoperation for post-laminectomy syndrome is only considered when all other treatments fail. Talk to your spine specialist to learn more about the treatment options available to you.
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