Post Laminectomy Syndrome

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Post-Laminectomy Syndrome (PLS), also known as failed back syndrome, is a chronic and painful condition that some patients experience after undergoing laminectomy back surgery. Vertebroplasty

A laminectomy is a surgical procedure that removes the lamina, a portion of the vertebrae that connects the spinous process (the protrusions felt on the back through the skin) to the main body of the bone, and any associated bone spurs to relieve pressure on spinal nerves that can occur in many back conditions.

PLS is not a diagnosis, but rather a general term to describe the chronic pain symptoms experienced by patients as they emerge from back surgery. The exact cause of PLS is unknown, however one prominent theory points to epidural fibrosis, in which the development of scar tissue during post-surgical healing compresses nearby nerve roots and causes pain.

Other possible causes include:

  • Surgical intervention at the wrong spinal level
  • Incomplete removal of the lamina
  • Arachnoiditis – inflammation within the protective layers of the spinal cord
  • Psychosocial problems, such as depression

Diagnosis and Treatment

Diagnosis of PLS is made difficult due to the many possible presentations of chronic pain post-surgery. A doctor must recognize the developing pattern of chronic pain and poor post-surgical outcomes. A physician may order laboratory or imaging studies to identify possible inflammation or other structural abnormalities where the lamina was removed. The physician may also perform a mental health screening to rule out any psychosocial causes. Treatment options will be different for every patient.

Some of the possible treatment options include:

  • Opioids can be used for pain management
  • Spinal cord stimulation
  • Adhesiolysis – the disconnection of fibrotic scar tissue after surgery

References

  • Post Laminectomy Syndrome – PainDoctor.com
  • Rabb, C. (2010). Failed back syndrome and epidural fibrosis. The Spine Journal. Vol 4(4), 486-488.
  • Nidus Information Services. (2011). Laminectomy. Patient Handouts. MD Consult Web site, Core Collection.
  • Rosenbaum, R.; Ciaverella, D. (2008). Disorders of Bones, Joints, Ligaments, and Meninges. Bradley: Neurology in Clinical Practice, 5th Ed. MD Consult Web site, Core Collection.
  • Chou, R. (2011). Subacute and chronic low back pain: Surgical treatment. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  • Bajwa, Z.; Smith, H. (2011). Overview of the treatment of chronic pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.