WHAT IS IT? (DEFINITION)
Post-laminectomy syndrome simply means there is pain that persists after a back or spinal surgery. The pain can occur in the back and/or leg(s). It usually follows a laminectomy surgery but it can occur after surgery on any part of the spine.
DID YOU KNOW?
This condition is also called Failed Back Surgery Syndrome (FBSS). One may then think that FBSS is caused by incorrect surgery or surgery that was done poorly. This is not always the case. FBSS can have multiple causes. In fact it has been suggested that we ditch the term FBSS and replace it with a more appropriate name; Postoperative Persistent Syndrome (POPS).
WHAT DOES IT FEEL LIKE? (SYMPTOMS AND SIGNS)
Common symptoms include diffuse, dull and aching pain involving the back and/or legs. Abnormal sensibility may occur and include sharp, pricking, and stabbing pain in the back or legs.
WHAT CAUSES IT? (PATHOPHYSIOLOGY)
There can be multiple causes of this condition. The can include one or more of the following:
Recurrent or persistent disc herniation (bulge) - removal of a disc at one spinal level can lead to a disc herniation at the same spinal level or a different level. This can occur shortly after surgery or even months or years later. Even the most complete surgical excision of a disc requires a part of the disc to be left behind. This disc can then re-herniate, anytime after surgery.
Spinal stenosis – can occur following surgery. This is when there is a compression of the spinal cord. Surgical scarring or bone spurs or thick ligaments around the spinal cord can cause this compression.
Epidural post-operative fibrosis – scarring following surgery can be common and this can be responsible for ongoing pain.
Adhesive arachnoiditis – this is when there is ongoing scarring that specifically affects the multiple nerves from a certain are of the spinal cord.
Nerve Injury – any number of delicate nerves can be injured during spinal surgery. The nerve injury can be temporary or permanent. Nerves can be cut, torn, or cauterised during surgery. Nerves could also be injured, by longstanding compression by herniated discs. Swollen bones or ligaments can compress nerves. Sometimes, nerves can just become sensitised without any injury occurring other than some mild bruising following the surgery.
Postoperative infection – very rarely infection can be a cause of ongoing pain after surgery.
WHAT HAPPENS BECAUSE OF IT? (CONSEQUENCES)
Uncontrolled or poorly managed pain can have many consequences. Some consequences can be easily managed but others require specialist management.
Pain leads to fear of moving so people reduce or stop moving. This leads to deconditioning. Deconditioning is a complex problem that follows a period of inactivity, bed rest or even just a sedentary lifestyle. Deconditioning causes a decline in physical, functional, psychological, and even social aspects of life. Deconditioning leads to weak muscles, stiff joints, reduced coordination, weak bones, poor sleep, high blood pressure. This can go on to cause depression, anxiety, low self-confidence and inability to enjoy life. This is called the downward spiral of chronic pain.
In short, uncontrolled pain is exhausting, physically and mentally and emotionally.
HOW DO YOU DIAGNOSE IT? (DIAGNOSTIC TESTS)
The main tests that your spinal surgeon or pain specialists will perform will be to make sure there are no serious causes of the pain. Serious causes include infection, bone fractures, disc herniations or broken screws or plates. These causes may require urgent management.If there is nothing serious causing the pain, your pain specialists can then focus on managing the pain and the consequences of the pain.
HOW DO YOU TREAT IT? (TREATMENTS)
The best treatment approach is so called multimodal and multidisciplinary. This is using more than one treatment at a time and sometimes more than one team member too. Medications will be optimised and managed. These include tablets and/or infusions. Most pain medications can be tried. These include nerve blocks and radiofrequency procedures may be needed. Epidural injections or epidural hydrodilation to break up scar tissue might be considered.
Spinal cord stimulation is a known an effective treatment for this severe pain syndrome.
If you have any questions just ask your pain specialist what treatments may be required to get your pain under control and get you back to life.
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Russo M, Van Buyten JP. 10-kHz High-Frequency SCS Therapy: A Clinical Summary. Pain Med. 2014 Nov 7. LINK
Rigoard P, Desai MJ, Taylor RS.Failed back surgery syndrome: What's in a name? A proposal to replace "FBSS" by "POPS"…. Neurochirurgie. 2015 Mar;61 Suppl 1:S16-21. LINK