Post-laminectomy syndrome is a broad term that encompasses a variety of scenarios in which a patient experiences new or similar back pain after spinal surgery. It is also sometimes referred to as failed back surgery syndrome because the only consistent criteria for post-laminectomy syndrome is that a patient has previously undergone spine surgery.
Failed back surgery syndrome is defined by the International Association for the Study of Pain as “lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location.”
During a laminectomy, a spine surgeon removes part of the spine, known as the lamina, to eliminate pressure on the nerve root that is causing pain, numbness, or weakness to the back, legs, or buttock. Because a laminectomy is most often performed on the lumbar spine (lower back), post-laminectomy syndrome has become synonymous with failed back surgery syndrome.
As the rate of spine surgeries increased significantly over the past 20 years, the incidence rate of post-laminectomy syndrome also has increased. As a result, neurosurgeons across the nation, including myself and my colleagues at Neurosurgery One, have improved the ways in which we diagnose and treat pain and weakness connected to the spine. Whenever possible, we recommend conservative treatments, such as physical therapy, injections, and medications, rather than surgery to help minimize the risk of post-laminectomy syndrome. If surgery is necessary, we recommend minimally invasive spine surgery or motion-preserving spine surgery if appropriate.
How common is failed back surgery syndrome?
According to national data, post-laminectomy syndrome, or failed back surgery syndrome, is diagnosed in anywhere from 10% to more than 40% of patients. Studies show that the prevalence of post-laminectomy syndrome is higher for patients who undergo more complex spine surgeries, with 30% to 46% of these patients experiencing continued or new pain after surgery. In comparison, the rate for is half that for patients who received a microdiscectomy, a minimally invasive surgery to remove part of the disc.
However, I believe those estimates are grossly inflated because failed back surgery is often used to define any type of chronic back pain condition without a known cause. From my experience, anecdotally, I treat roughly 5-10% of patients every year who fall into the post-laminectomy syndrome category. By that, I mean these patients do not have another known cause for their symptoms.
What are the risk factors of post-laminectomy syndrome?
The first issue that can lead to post-laminectomy syndrome is having spine surgery based on an improper diagnosis or for a condition that cannot be helped with surgery, such as osteoarthritis. I would never encourage a patient to undergo spine surgery unless we know the exact location of the issue and there is medical evidence that shows the condition can be successfully treated with surgery.
In tandem with a proper diagnosis is being a viable candidate for surgery. Obesity, smoking, anxiety, and depression have all been associated with a higher likelihood of post-laminectomy syndrome. I work closely with all my patients to help them improve their health as much as possible prior to surgery. Even quitting smoking for a few days or weeks before and after surgery can improve outcomes.
Many of my patients benefit from our Bone Health & Spine Fracture Clinic to strengthen their bones prior to surgery. And our Enhanced Recovery After Surgery program has been shown to reduce surgical complications, recovery time, and opioid usage.
Another reason post-laminectomy syndrome may arise is that patients’ expectations are not aligned with what can reasonably be expected from the surgery. One of the things I strive to do is ensure my patients – and their families – fully understand what to expect from surgery. Many patients who come to me for a second opinion or after a failed back surgery did not fully understand what they should expect post-surgery. As a patient, there are three things to keep in mind if you are considering back surgery:
- How much will your pain be reduced?
- What other symptoms are you experiencing that could improve with surgery?
- Is any part of your pain or other symptoms due to a secondary condition that will not improve with surgery? (For example, you may have a herniated disc and arthritis. While surgery can treat the pinched nerve, you may still experience pain from the arthritis.)
- What is a realistic “new normal” for you after surgery?
Some patients expect to feel like they did in their 30s after having back surgery in their 60s, but that is not realistic. Other patients assume all their pain or conditions will be solved with one surgery, and, oftentimes, that is not possible. I encourage patients to ask as many questions as possible prior to surgery so that you fully understand what’s realistic in terms of your pain, mobility, and other symptoms like weakness. Being misaligned on expectations causes disappointment for everyone involved, including the surgeon.
Another risk factor for post-laminectomy syndrome is development of a new condition. For instance, pain that seems to be coming from the same location as your fusion could be due to deterioration in the discs above or below. That is not failed back surgery syndrome, but rather a whole new diagnosis.
How can I reduce my risk of post-laminectomy syndrome?
If you have been told you should have spine surgery, here are five tips I recommend to reduce your risk of having continued or new pain after lumbar surgery:
- Research the spine surgeon you have selected to perform your surgery. While all neurosurgeons and orthopedic surgeons are trained in spine surgery, some specialize in this area and have more experience performing certain procedures. Ask about patient outcomes, infection rates, number of surgeries performed, and the like. You have choices in providers, so do your homework and choose a neurosurgeon who you feel comfortable with and confident in performing your back surgery.
- Ask your spine surgeon for your exact diagnosis and to provide you with the studies that support surgery.
- Improve your overall health before and after surgery. Spine surgery is rarely an emergency surgery, so take the time to stop smoking, improve your diet, and get treatment for depression or anxiety. If you’ve been diagnosed with weak bones, make an appointment with our Bone Health Clinic.
- Ask your spine surgeon what to expect after surgery. Then, at your next appointment, tell your surgeon what you think you can expect. That gives the surgeon an opportunity to clarify any miscommunication or misunderstandings about expectations. Write down what to expect so that down the road you can compare what you’re feeling to what you wrote down.
- Obtain a second opinion. Good surgeons will not be offended if you seek a second opinion. In fact, I encourage it as it will help give you confidence, which has been shown to help improve outcomes.
What should I do if I think I have post-laminectomy syndrome?
If you believe you may have post-laminectomy syndrome, I encourage you to first compare what you’re feeling to the expectations you wrote down before your surgery. If your pain is worse than what you were told to expect or you’ve developed new pain or symptoms, talk to your spine surgeon. You may need additional physical therapy or post-surgery rehabilitation; you may have developed a new condition that can be treated; or there may be additional non-surgical options that can help reduce your pain further.
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Dr. Joshua Beckman, MD, FAANS, is a board-certified neurosurgeon who specializes in spine surgery. Dr. Beckman sees patients in Neurosurgery One’s Lakewood and Denver clinics. Prior to joining Neurosurgery One, Dr. Beckman served as the director of spine surgery at San Antonio Military Medical Center, the nation’s largest military hospital and Level I trauma center, where he developed special expertise in treating severe spinal conditions
