Post Laminectomy Syndrome treatment options
Ross Hauser, MD, Caring Medical Regenerative Medicine Clinics, Fort Myers, Florida
David N. Woznica, MD, Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Danielle R. Steilen-Matias, MMS, PA-C, Caring Medical Regenerative Medicine Clinics, Oak Park, Illinois
Post Laminectomy Syndrome treatment options
A laminectomy is a surgical procedure to relieve “pinched nerves.” Since the nerve is “compressed,” the surgical procedure is also called “Decompression Surgery.” The procedure removes bone from the spinal vertebrae, the portion called the Lamina, to take the pressure off the affected nerves. This article will examine what happens when the laminectomy procedure is not as successful as the doctor and patient hoped for and examines the resulting Postlaminectomy Syndrome and what treatments can be offered for it.
Many people have successful laminectomy procedures. These are typically not the people we see in our office. We see the people who suffer from Post Laminectomy Syndrome or Failed Back Surgery Syndrome who are looking for non-surgical options to help their back pain. All these people have unique challenges, there stories go something like this:
I went in for the surgery because I had terrible nerve pain shooting into my legs. I was told that my surgery was successful but I continued to have pain. It was not the same pain as before the surgery, it is a different pain that centers in my back at the L4/L5 site where I had the laminectomy. I traded one pain for another.
I had a laminectomy for lightning bolt type pain in my lower back. Following the surgery, I still had the same pain. I was give spinal block injections that did not help. I tried a variety of conservative treatments, physical therapy, which I tried even though it did not help me before my surgery, acupuncture, and yoga. I am being told now that spinal fusion is my best option. I just can’t see myself going through another surgery.
“Degenerative processes may result in foraminal stenosis development over time, even after a successful surgery.”
The problem with Laminectomy is that it removes structure from the spine. When you remove one supporting structure from anything, another supporting structure is going to take on added stress and pressure. So is the case for Laminectomy.
This problem is addressed in an October 2019 study. Here neurosurgeons from some of South Korea’s leading medical universities discussed the realistic surgical options for patients with an average age of 72 who suffered from Post Laminectomy Syndrome. The study appears in the journal World neurosurgery.(1) Again, they are talking about a successful surgery that led to the problem of stenosis because of a compromise of structural integrity. Listen to the complexity of the surgery to fix this.
“Post Laminectomy syndrome (PLS) or failed back surgery syndrome is a condition characterized by persistent pain following a back surgery. Degenerative processes may result in foraminal stenosis development over time, even after a successful surgery.
Percutaneous endoscopic lumbar foraminotomy (PELF) offers a minimally invasive means of treating foraminal stenosis after a back surgery. The transforaminal endoscopic approach can provide a better access angle to achieve a sophisticated foraminal decompression with less facet and dural injury.”
The recommendation to have a second surgery to alleviate pain caused by the first surgery is a very tricky procedure as outlined in the above study. Even with good success rates in the second surgery, pronouncing it successful, what happens if, the second successful surgery eventually develops into a painful spinal problem? In the above research the neurosurgeons described their own technique as a “sophisticated foraminal decompression with less facet and dural injury.” There is still injury. Can these patients then handle a third procedure? There is of course great concern with what to do with patients with continue to suffer from chronic pain following back surgery, even after a successful back surgery. This is why patients explore non-surgical options.
Degenerative processes may result in foraminal stenosis development over time, even after a successful surgery. The narrowing of the intervertebral foramina is illustrated to the right.
If you want to avoid another surgery, Intensive Interdisciplinary Pain Rehabilitation treatment will be needed after the failed laminectomy
We are going to go back to a 2010 study published in the medical journal Canada Physiotherapy, (2) the Journal of the Canadian Physiotherapy Association. It gives an outline of what Intensive Interdisciplinary Pain Rehabilitation is and what a patient with failed laminectomy syndrome may face. We are going to use this knowledge to discuss new and recent studies on Post-laminectomy syndrome treatment.
Rehabilitation became a full-time job for patients
- If you were one of these patients followed in this research study, you attended 7–8 weeks of outpatient treatment, which consisted of 3–4 clinical contact hours per day, usually 5 days per week.
- The total clinical contact time ranged from 130 to 150 hours per patient.
- Patients were also asked to perform additional exercises and related homework for approximately 1–2 hours per day, and their compliance was monitored. Program cost ranged from $8,000 to $12,000 per patient. (That is in 2010 Canadian dollars).
The treatment team consisted of:
- cognitive–behavioural therapists, kinesiologists (movement specialists), occupational therapists, physiotherapists, physicians, psychologists, biofeedback therapists, and massage therapists.
- Supplemental team members included chiropractors, dietitians, physiatrists, and psychiatrists.
Together, these components were designed to enhance each patient’s understanding of chronic pain and to promote effective use of pain-management skills. Patients were taught effective physical and mental pain-coping techniques within a supportive, goal-oriented atmosphere to increase self-efficacy in pain management.
Let’s point out again, the aptly described intensity of this program for failed surgery patients and the hours dedicated towards rehabilitation was in affect a full time job.
- You have a failed back surgery problem – Post-laminectomy syndrome
- You do 7 to 8 weeks, 5 days a week, 3-4 hours a day of intensive rehabilitation.
- You are taught to manage your failed surgery pain on you own for the rest of your life.
This is a suggested successful pain management plan for post-laminectomy syndrome. Certainly it is better than another surgical attempt.
Nurses tell an even more confusing, demanding, and complicated story about what patients go through in the multidisciplinary approach
In April 2019, nine years after the above study, a survey was taken of nurses caring for patients with chronic pain syndromes. This survey’s results were published as a research study in the International journal of nursing sciences.(3)
- The nurses experienced allocation of limited resources as challenging, especially when the dilemma between accepting new patients from the waiting list and offering follow-up to existing patients became apparent. Multifaceted treatment was perceived as vital, although resources, priorities, and theoretical understanding of pain within the team were challenging.
- The needs for multifaceted and integrated treatments in chronic pain management were obvious, although this approach appeared to be too demanding of resources and time. Stronger cooperation between pain clinics in specialist care and health care providers in primary care to ensure better patient flow and treatment is required.
Is a Spinal Cord Stimulator A Better Answer?
In April 2017, researchers at the Mayo Clinic published similar findings. Of note in their research is the study title: The Effectiveness of an Intensive Interdisciplinary Pain Rehabilitation Program in the Treatment of Post-Laminectomy Syndrome in Patients Who Have Failed Spinal Cord Stimulation. (4)
The Mayo doctors looked at patients who had Post-laminectomy syndrome and were first treated with Spinal Cord Stimulation. For whatever reason; time, ability, commitment, knowledge, the patients in this study and their physicians believed Spinal Cord Stimulation was the way to go. It was not.
Here is the Mayo Clinic findings:
- Intensive, interdisciplinary pain rehabilitation provides an effective therapeutic modality for patients with post-laminectomy syndrome who have failed spinal cord stimulation by decreasing pain levels and by increasing functional status and self-efficacy.
Causes of Chronic Post-Surgical Spinal Pain and why another surgery is being recommended
In this video, Ross Hauser, MD describes the 5 main reasons that back surgery failed to help the patient’s condition.
- The surgery did not address the actual cause of the patient’s pain. The diagnosis is wrong. A main cause of ‘”missed” low back pain is injury to the Sacroiliac Joint. If your MRI showed disc degenerative disease and you had the discs operated on but the Sacroiliac Joint was not addressed, pain will continue after the surgery.
- The surgery made the lower back MORE unstable. Foraminotomy, Laminectomy, Microdiscectomy, disc surgery, all have to remove parts of bone in the spine.
- The “missed secondary problem.” The surgery may have successfully addressed what was considered your primary problem, but, you really had two problems. This could be a multi-segmental problem that was not discovered until after the first surgery.
- Too much sitting after surgery, possibly too much bed rest.
- More rare, scar tissue pinches on the nerves. This is discussed at length below.
Looking for treatment answers: Misinterpretation that a herniated disc as causing low back pain is the most common reason behind the spinal surgeries that result in post-laminectomy chronic pain syndrome
In the above video, Ross Hauser, MD explains five common reasons that a patient suffered from Failed Back Surgery Syndrome. A main reason was that the surgery may have chased the wrong thing.
In Brazil, doctors write in the medical journal BMC research (5) notes that as many as one-third of the patients undergoing surgery for the correction of lumbar disc conditions experience recurrent postoperative symptoms. The cite research that suggests upwards of 40% of the patients undergoing lumbar surgery will not experience benefits from the procedure and that the condition will worsen in up to 10%.
The high prevalence in this study, the Brazilian team noted was perhaps due to inaccurate indications for surgery. They note several studies as having suggested suggested that the misinterpretation that a herniated disc is causing low back pain is the most common reason behind the spinal surgeries that result in post-laminectomy chronic pain syndrome beginning immediately after the procedures.
This misinterpretation may be partially caused by an overestimation of the anatomical findings that are revealed during the imaging evaluations but are not related to the lumbago and usually do not explain the pain or justify surgical intervention.
Hasty diagnoses using MRI or other imaging methods rather than clinical observations can lead to unnecessary treatments (including back surgery surgery) that, in turn, cause iatrogenic conditions.
- The prevalence of post-laminectomy pain was 60 %.
- All of the patients presented with chronic, intense pain that had lasted an average of 7.22 years.
- The prevalence of neuropathic pain was 89.9 %.
- None of the patients exhibited high levels of physical fitness.
- There was a strongly positive and significant relationship between the anxiety and depression scores.
The patients in this study are patients typical to what we see in our clinics and hope to help. If the surgery did not address the correct issue we hope that we can with non-surgical regenerative medicine injections to include Prolotherapy and PRP. We will now explain these treatments.
Comprehensive Prolotherapy for failed disc surgery: the realistic goals
Comprehensive Prolotherapy is a treatment designed to strengthen weakened soft tissue in the spine and bring stability to the area through injections, not surgery. We recommend a consultation for those on narcotics and those with spinal cord stimulators. In the case of spinal stimulators, we ask patients to bring in their X-rays showing exactly where the spinal cord stimulator is placed. As long as we can see where the stimulator electrodes are located we can safely do Prolotherapy.
Prolotherapy attacks the problems of a damaged spine instead of suppressing the symptoms. While Prolotherapy is an alternative to disc surgery, it can also help when disc surgery has already occurred yet failed to address the root issue.
Prolotherapy can be effective is treating Failed Back Surgey and Post Laminectomy Syndrome
In research from Harold Wilkinson MD, published in the medical journal Pain Physician, (6) Dr. Wilkinson looked at difficult back pain cases, “Of the patients studied, 86% of patients had undergone prior lumbar spine surgery and all were referred for neurosurgical evaluation for possible surgery,” to see is simple dextrose Prolotherapy would be of benefit.
Here are some learning points:
- Thirty of the 35 patients in this study had been referred to a neurosurgeon because of persistent pain and disability despite prior low back surgery and were referred for consideration for possible additional surgery.
- After inclusion in this study, only four patients subsequently underwent additional surgery, though 29 patients requested repeat injections.
- This suggests that painful enthesopathies can be major pain generators for some patients and that diagnosing their condition as being due to a focal problem and treating those sites with prolotherapy can be an effective and “minimally invasive” treatment alternative. (The enthesis is the point at which the connective tissue structures, such as a joint capsule, fascia, ligament, tendon, or muscle attach to the bone.)
Please refer to for more discussion Cervical pain Adjacent segment disease following neck surgery for a discussion of the cervical spine.
Platelet Rich Plasma Therapy in combination with Prolotherapy
Some doctors may recommend the use of Platelet Rich Plasma to help patients with failed back surgery syndrome. Platelet Rich Plasma is an injection of your concentrated blood platelets into the area of pain. The concentrated blood platelets bring healing and regenerating growth factors to the areas possibly damaged or affected by surgery.
Recent research says that Platelet-rich plasma (PRP) represents an additional approach, as it has shown some promise in bone regeneration, and should be explored for its potential role in limiting spinal fusion surgery failures.(7)
In our practice, PRP is used in conjunction with dextrose Prolotherapy to stimulate healing of the ligament and tendon attachments of the spine that cause pain, muscle spasms, and degenerative disc and other conditions.
Laminectomy for cervical stenosis complications
Doctors at the University of Iowa summarized the reasons for laminectomy for cervical stenosis and possible complications of excessive spinal curvature. In their study they report:
Laminectomy has been regarded as a standard treatment for multi-level cervical stenosis. Concern for complications such as kyphosis (Hunchback syndrome) has limited the indication of multi-level laminectomy; hence it is often augmented with an instrumented fusion.
Laminectomy resulted in 57% increase in flexion (bending) as compared to the normal intact state, creating a concern for eventual kyphosis–a known risk/complication of multi-level laminectomy in the absence of fusion.
Increased disc stresses were observed at the altered and adjacent segments post-laminectomy in flexion.
Can these treatments help you?
If this article has helped you understand problems of Failed back surgery syndrome treatment options and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists
If you have questions about Post-laminectomy syndrome and back pain Get help and information from our Caring Medical staff
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