Spine surgeons perform back surgery to reduce or eliminate chronic back or leg pain due to spinal nerve compression. Should surgery fail to achieve all of its desired outcomes, the result is known as Post-Laminectomy Syndrome (sometimes called Failed Back Syndrome). If you are among those who continue to suffer from back and or leg pain after surgery, you know the frustration and despair this can cause. What you may not know is that there is hope. When accurately diagnosed, most post-surgical pain can be managed effectively.
About 500,000 spine surgeries are performed in the U.S. each year and yet, surgery is not always successful for everyone. In fact, up to 20 percent of Americans who undergo spine surgery each year still have some degree of persistent back or leg pain afterwards. When spine surgery does not achieve the results desired by you and your physician, this condition is often referred to as Post-Laminectomy Syndrome.
There are a variety of factors that may cause Post-Laminectomy Syndrome. In many cases, the spinal nerve root, which has been decompressed by the surgery, simply does not fully recover from its prior trauma and continues to be a source of chronic nerve pain or sciatica. In other instances, the body’s way of healing includes scar formation, which can surround the nerve roots and give rise to chronic pain. Another relatively common occurrence is the presence of structural changes in the spine that develop above or below the site of a spinal fusion. Other causes include recurrent or new disc herniation, post-operative spinal or pelvic ligament instability (such as SI joint dysfunction*), and myofascial pain*.
The symptoms of Post-Laminectomy Syndrome depend on the cause. You may continue to experience pain similar to the pain you had prior to surgery. Symptoms may also include dull and achy pain that is primarily located in the spinal column. You might experience sharp, pricking, and stabbing pain called neuropathic pain that radiates from the back down the legs.
Neuropathic pain is caused by a primary injury to the nervous system. In Post-Laminectomy Synrome, the nerve root injury caused by the spinal disorder that led to surgery may cause neuropathic pain. Neuropathic pain is associated with abnormal sensitization of the spinal nerves followed by “central sensitization” of the spinal cord, which receives the initial pain signals. “Central sensitization” leads to the reorganization of pain pathways resulting in chronic pain. One result of this reorganization is the experience of allodynia, which is the interpretation of a non-painful stimulus as painful. For example, a light touch or brush against the skin would cause a painful experience. Hyperalgesia may also occur, which is an increased response to a painful stimulus. For instance, heat or a light pinprick may be perceived as more intense pain than typically expected.