Introduction: Postlaminectomy pain syndrome, also known as failed back surgery syndrome, is a challenging condition that can develop following posterior lumbar fusion surgery. This blog aims to shed light on the causes, symptoms, and treatment options for individuals experiencing back and leg pain after undergoing spinal surgery.
Manifestation: Following posterior lumbar fusion surgery, some individuals may experience persistent or recurrent pain in the back and legs. This pain can manifest in various ways, including:
- Chronic back pain: Persistent discomfort in the lower back, often localized around the surgical site.
- Radicular pain: Shooting or burning pain that radiates down one or both legs, often following the path of the affected nerve roots.
- Neuropathic pain: Tingling, numbness, or electric shock-like sensations in the legs or feet.
Postlaminectomy pain syndrome can significantly impact an individual’s quality of life, leading to physical limitations, emotional distress, and reduced functional ability. The persistence of pain despite surgical intervention can be frustrating and challenging to manage, requiring a comprehensive approach to treatment.
Causes: Several factors can contribute to the development of postlaminectomy pain syndrome, including:
- Ongoing nerve compression or irritation: Despite surgical decompression, nerve impingement may persist or recur.
- Scar tissue formation: Adhesions or fibrous tissue around the surgical site can compress nerves and cause pain.
- Adjacent segment degeneration: Wear and tear on adjacent spinal segments following fusion surgery can lead to new pain symptoms.
- Surgical complications: Such as hardware failure, infection, or improper fusion can result in persistent pain.
Treatment Options:
- Conservative Measures:
- Physical therapy: Targeted exercises to improve strength, flexibility, and posture can help alleviate pain and improve function.
- Medications: Pain relievers, muscle relaxants, and neuropathic pain medications may be prescribed to manage symptoms.
- Epidural steroid injections: Administered around the affected nerve roots to reduce inflammation and provide temporary pain relief.
- Spinal Cord Stimulation (SCS):
- SCS is a minimally invasive procedure that involves implanting a small device near the spinal cord to deliver electrical impulses that interrupt pain signals.
- Candidates for SCS typically have chronic, neuropathic pain that has not responded to conservative treatments or surgery.
- Studies have shown favorable outcomes for SCS in the management of postlaminectomy pain syndrome. For example, a meta-analysis by Kumar et al. (2018) [1] reported significant improvements in pain and functional outcomes with SCS.
Success Rates and Considerations: Success rates for SCS in the treatment of postlaminectomy pain syndrome vary but can be significant for appropriately selected patients. Factors such as patient selection, proper device programming, and adherence to postoperative care guidelines can influence outcomes. It’s essential for individuals considering SCS to undergo a thorough evaluation by a pain management specialist to determine candidacy and discuss expectations.
Conclusion: Postlaminectomy pain syndrome can present significant challenges for individuals who have undergone spinal surgery, impacting their daily lives and overall well-being. By understanding the causes, symptoms, and treatment options for this condition, patients and healthcare providers can work together to develop a comprehensive management plan aimed at reducing pain and improving function.
Apollo Pain Management is proud to offer this state-of-the-art procedure to our patients. Ask your APM physician if Spinal Cord Stimulation is right for you.
Reference:
- Kumar K, Taylor RS, Jacques L, Eldabe S, Meglio M, Molet J, et al. Spinal cord stimulation versus conventional medical management for neuropathic pain: a multicentre randomised controlled trial in patients with failed back surgery syndrome. Pain. 2007;132(1-2):179–88.
Author R James Warren, MD MS Me