Post-Laminectomy Syndrome Treatments

Marc Darrow, MD

Post-Laminectomy Syndrome is part of the umbrella diagnosis of Failed Back Surgery Syndrome. If you have been diagnosed with this problem you probably suffer from chronic and persistent back pain, just as bad or worse than the pain you suffered from before you had a laminectomy. Prior to surgery you were probably told that you back or leg pain was due to spinal nerve compression. The surgery was offered then to help address these problems.

There are many people who have had successful laminectomy and they are very happy with the results. Others found good relief from the procedure, others found fair relief, others still found no relief. In some, the pain was made worse.

When someone contacts our office with a diagnosis of Post-Laminectomy Syndrome we have to get information from them that will allow us to make a realistic assessment if they are someone that we can help avoid a revision surgery, reduce their pain and increase their function.

We can help some people with Post Laminectomy Syndrome, we may not be able to help others. How do we know who we may be able to help? We talk to people on the phone, we discuss their pain and symptoms and what happened after the surgery. If we think we can help someone, we tell them to come in for a consultation. If we do not think we can help, we don’t.

Post-laminectomy syndrome has many causes and many symptoms

In some people,

  • patients had spinal surgery that was considered successful, later on they developed a new and different back pain.
  • patients had spinal surgery that was considered successful, but their back pain did not go away. (In many cases the back surgery was successful, the problem is that the surgeins di not find the true cause of the patient’s pain).
  • patients had spinal surgery that was considered a “failed back surgery.” Not only did the surgery not help the patient’s pre-surgical pain, but the surgery made the patient’s situation worse.
  • patients then moved onto pain management and opioid usage. Some developed opioid intolerance and this caused an increase in their pain.

Treatment options for the patient diagnosed with Post-Laminectomy Syndrome

The treatment options for Post-Laminectomy Syndrome is typically limited to more surgery or pain management. Pain management may include the following:

  • Spinal cord stimulation device.
  • Opioid medications.
  • Exercise or physical therapy programs
  • Some patients may require coping strategies and counselling.

An October 2021 study (1) aimed to evaluate the change in numerical rating scale (NRS) score and interventional procedures performed on patients with post-laminectomy syndrome whose numerical rating scale score 7 and above. To explain the pain numerical rating scale ranges from 0 – 10 a score of 7 or above indicates severe pain.

The research team examined the files of 107 patients, including 69 women and 38 men, aged 18 years and over with post-surgical pain.

  • With interventional procedures, 48.5% of patients had a reduction in pain of more than 50%.
  • The success rate was 66.7% in patients with radicular pain.
  • Pain relief was achieved in 28.8% of patients who underwent transforaminal epidural steroid injection,
  • Pain relief in patients undergoing dorsal root ganglion pulsed radiofrequency reached 44.4%.

The researchers here concluded that “Post-laminectomy syndrome is not usually caused by a single pathology, and more than one intervention and recurrence are often needed. Post-laminectomy syndrome is a disease that requires a multidisciplinary approach and multiple treatment options must be decided according to the patient. More research is needed on treatment options.”

This idea of multi and different treatments was also suggested by doctors at the Mayo Clinic in a 2018 paper (2) which suggested a combination of all these treatments may help post-laminectomy syndrome patients who have previously undergone spinal cord stimulation and failed.

Do spinal cord stimulators help get post-laminectomy syndrome patients off of opioids?

A January 2022 paper (3) tried to sought out the problem of previous studies evaluating spinal cord stimulation for post-laminectomy syndrome that yielded mixed results. Specifically, when it came to understanding opioid usage in post-laminectomy syndrome patients, did the spinal cord stimulation help the patient get off the opioids?

This was a larger study assessing the outcomes of over one-half million patients (552,937 patients suffering from post-laminectomy syndrome who had a received a spinal cord stimulation implant.)

  • The average age of the patients was 60 years old.
  • 55.3% were female.

Compared with those who did not receive an a spinal cord stimulation implant, individuals who received an spinal cord stimulation were more likely to be using opioids preimplantation but less likely to be using opioids after spinal cord stimulation implantation. But how much? According to the study authors: “These findings suggest that under real-life conditions, SCS was associated with small, clinically questionable associations with opioid discontinuation and not starting opioids in the context of post-laminectomy syndrome.” In terms of statistics, almost no effect at all.

PRP injections

  • PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Research has shown PRP to be effective in treating degenerative disc disease by addressing the problems of spinal ligament instability.

Recurring disc herniation and stenosis

If the patient continues to have recurring disc herniation, PRP injections may help by addressing the possible cause of the disc herniation.

  • Disc herniation can be caused by injured ligaments and tendon attachments to the bone. Realistically, pain after surgery can find its source in the same pain generators that were activating before the surgery, the abnormal or hypermobility of the vertebrae.
  • If the ligaments and tendons of the spine are loose, the vertebrae can cause compression throughout the spine. It is possible that the laminectomy may have found one source of the pain, but not all the sources of the pain. Further, as the spine continues to suffer from degenerative disc disease, more vertebrae will start moving around. It may be at this time a fusion would be recommended to a patient already suspicious of more surgery.

The ligaments which hold the vertebrae to each other may have been the cause of the patient’s pain all along and the continued cause of pain after the procedure. Laminectomy does not address ligament damage nor does MRI see it.

Tendon and Muscle damage

PRP injections may help if there is a situation of tendon and muscle damage. In a situation like this we would examine the spine and look for tenderness and weakness in the muscle attachments / tendons and the spinal ligaments. If these structures are damaged, they may be treated with Platelet rich plasma therapy.

To make the spinal muscles strong, and build your “core,” you would need resistance training. A problem following fusion surgery is that not only are the muscles damaged, but the muscle tendons are damaged as well. Resistance training or post-surgical rehabilitation cannot be successful if the tendons and muscles are not strong enough to flex and contract enough to build new muscle. Further, the muscle will shrink and atrophy making the spine that much more painful.

There has to be a realistic expectation of what these treatments can do and what they can’t do. If there are issues of continued pain following a surgery, PRP  may be effective in helping pain if there are issues with ligament and tendon instability causing spinal instability. PRP may help strengthen the tendon/muscle attachments and help patients who suffer from continued spasms.

An assessment and and evaluation

If you suffer from Post-Laminectomy Syndrome, stem cell therapy may be able to help. Please use the form below and send in an email to me. This way we can help assess your situation.

Ask Dr. Darrow

Medical references for this article

1 Akkemik Ü, Onay M, Güleç MS. Effectiveness of interventional procedures for post-laminectomy syndrome: A retrospective study. The journal of the Turkish Society of Algology. 2021 Oct;33(4):253-60.
2 Bailey JC, Kurklinsky S, Sletten CD, Osborne MD. The effectiveness of an intensive interdisciplinary pain rehabilitation program in the treatment of post-laminectomy syndrome in patients who have failed spinal cord stimulation. Pain medicine. 2018 Feb 1;19(2):385-92.
3 Vu TN, Khunsriraksakul C, Vorobeychik Y, Liu A, Sauteraud R, Shenoy G, Liu DJ, Cohen SP. Association of Spinal Cord Stimulator Implantation With Persistent Opioid Use in Patients With Postlaminectomy Syndrome. JAMA network open. 2022 Jan 4;5(1):e2145876-.

 

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