Post-Laminectomy Syndrome

Post-Laminectomy Syndrome is a term used to describe persistent pain and other
symptoms that continue after back surgery

Inappropriate surgery like a single level decompression for a multi-level problem or surgery done in a patient with predominantly mechanical back pain are causes of failure of surgery, wrong level decompression is a common cause. Improper patient selection for surgery is an important factor in patient developing FBSS. Surgery can itself lead to new pain generators like instability caused due to decompression or breakage or misplacement of implant. Altered Biomechanics in the Operated spine, Changes in load distribution may accelerate degeneration in segments adjacent to the lumbar fusion, which could lead to new sources of pain.

It is a common condition that affects a significant number of people who have undergone spinal surgery. Psychosocial wellbeing and depression are strong predictors of poor outcome of surgery, smokers and obese patients are known to have poorer outcomes.Although more than 50% of primary spinal surgeries are successful, no more than 30%, 15%, and 5% of the patients experience a successful outcome after the second, third, and fourth surgeries, respectively.

There are also chances of a recurrent disc, nerve root entrapment due to postsurgical fibrosis, battered root syndrome, pelvic incidence and lumbar lordosis mismatch. Epidural fibrosis following spine surgery contributes to postoperative chronic pain through compression. Paraspinal muscles are potential pain generators if surgery is not conducted appropriately.

Successful management of FBSS is quite challenging. Given its multifactorial pathology, FBSS should be approached in a multifactorial fashion. Patients with failed back surgery syndrome constantly describe long lasting pain, which, over time, predisposes them to a number of significant psychologic complications. Each patient requires an individualized approach. Treatment of FBSS could involve medications, physical therapy, epidural steroid injection or facet joint injection, percutaneous adhesiolysis insertion of a spinal cord stimulator(neuromodulation) or re-surgery.

Our approach aims at treating the Failed back surgery patients by targeting one pain generator that is often ignored, the muscles. The patient is assessed thoroughly and the pain generators are identified. The pain arising from disc, nerve compression or facet joint is treated by xray guided injections and then followed by Ultrasound guided dry needling of muscles of back, legs. This treatment is performed in multiple sessions. Gradually patient is allowed to increase his activities and any pain that aggravates due to activity is treated with dry needling.

Physiotherapy aims to improve the muscle deconditioning which helps to decrease pain, improve stability, posture and mobility. It is always incorporated as a part of our treatment.

Post-Laminectomy Syndrome

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