Post-laminectomy syndrome

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Ross Hauser, MD and Katherine L. Worsnick, MPAS, PA-C

Post-laminectomy syndromeA laminectomy is a surgical procedure to relieve “pinched nerves.” The procedure removes bone from the spinal vertebrae 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 Post-laminectomy syndrome and what treatments can be offered for it.

See our main page, Prolotherapy for back pain for more treatment information. If you have questions about Post-laminectomy syndrome and back pain, Get help and information from our Caring Medical staff

Intensive Interdisciplinary Pain Rehabilitation treatment needed after the failed laminectomy

We are going to go back to a 2010 study published in the medical journal Canada Physiotherapy, 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 a later study from the Mayo Clinic on Post-laminectomy syndrome.

Rehabilitation became a full-time job for patients

  • If you were one of these patients 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.[1]

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.

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.

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. [2]

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 Brazil, doctors write in the medical journal BMC research 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.

More findings:

  • 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.3

Laminectomy for cervical stenosis complications

Prolotherapy vs. SurgeryDoctors 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. Please see our article on Cervical Neck Pain for more discussions.

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.[4]

Post-laminectomy syndrome is component failed back surgery syndrome. For Prolotherapy as possible treatment options please see our article failed back surgery syndrome.

If you have questions about Post-laminectomy syndrome and back pain Get help and information from our Caring Medical staff

1 Bosy D, Etlin D, Corey D, Lee JW. An interdisciplinary pain rehabilitation programme: description and evaluation of outcomes. Physiotherapy Canada. 2010 Oct;62(4):316-26. [Google Scholar]  interdisciplinary pain rehabilitation programme: description and evaluation of outcomes]

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. 2017 Apr 11:pnx060.  [Google Scholar]

3 Garcia JB, Rodrigues DP, Leite DR, do Nascimento Câmara S, da Silva Martins K, de Moraes ÉB. Clinical evaluation of the post-laminectomy syndrome in public hospitals in the city of São Luís, Brazil. BMC Res Notes. 2015 Sep 17;8:451. doi: 10.1186/s13104-015-1400-9. [Google Scholar]

4 Kode S, Kallemeyn NA, Smucker JD, Fredericks DC, Grosland NM. The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study. The Iowa orthopaedic journal. 2014;34:150. [Google Scholar]

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