Post-Laminectomy Syndrome (PLS), also known as failed back syndrome, describes a chronic, painful condition that some patients after undergoing back surgery, specifically a laminectomy1.
The spine is comprised of bony vertebra stacked upon one another from the pelvis to the skull, which is designed to protect the spinal cord and its associated nerve roots. Each vertebra has an opening in the center which creates a canal for the spinal cord. The lamina is 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. A laminectomy is a surgical procedure that removes the lamina and any associated bone spurs to relieve pressure on spinal nerves that can occur in a variety of back conditions2.
Post-Laminectomy Syndrome is not a diagnosis, but rather a general term to describe a variety of chronic pain syndromes experienced by patients as they emerge from back surgery1. The exact cause of Post-Laminectomy Syndrome 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 include3:
- Surgical intervention at the wrong spinal level
- Incomplete removal of the lamina
- Arachnoiditis, or inflammation within the protective layers of the spinal cord
- Psychosocial problems, such as depression, interfering with recovery
Because of the diversity of potential causes and the variety of different chronic pain syndromes that can result as a consequence of PLS, the condition can be a difficult one to treat.
Post-Laminectomy Syndrome Diagnosis and Treatment
Diagnosis of Post-Laminectomy Syndrome is made following surgery, as a doctor recognizes a developing pattern of chronic pain and poorer post-surgical outcomes than expected. 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 are situation-dependent and must be tailored to each patient individually. Some of the possible treatment options include1, 4, 5:
- Opioids can be used for pain management, however responses are unpredictable. The side effects of long-term opioid use can be serious, and long-term outcomes aren’t well understood
- Spinal cord stimulation via placement of electrodes into the epidural space of the spinal cord thought to be associated with the pain may be appropriate for some patients. The electrodes apply an electric current to interfere with pain conduction pathways. While the outcomes of spinal cord stimulation can be good, there is a high rate of complications associated with electrode implantation
- Adhesiolysis or the disconnection of fibrotic scar tissue after surgery may also be an option. During adhesiolysis, the scar tissue can be mechanically removed with special instruments or chemically removed via injection of saline or other solutions
Post-Laminectomy Syndrome can affect patients long-term, and significantly affect an individual’s lifestyle and ability to return to work. With proper treatment, however, pain can often be reasonably managed.
- 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.