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Failed Back / Post-Laminectomy Syndrome

What is Failed Back/Post-laminectomy Syndrome?

Failed back surgery syndrome is a term used to describe poor results from previous spine surgery. A laminectomy is a procedure to remove bone from the back of the spine in order to relieve pressure on the spinal nerves causing pain. Continued or recurrent pain following this procedure is referred to as post-laminectomy syndrome.

Causes of Failed Back/Post-laminectomy Syndrome

Success with the chosen procedure may vary depending on your condition. Failure mainly occurs because the source of pain was not properly identified.

Other causes of failure include:

  • Failure of fusion
  • Development of a new lesion (source of pain) in an adjacent spinal level
  • Inadequate nerve decompression
  • Recurrent spinal stenosis or disc herniation
  • Nerve damage before or during surgery
  • Development of scar tissue around the nerve
  • Secondary source of pain remains untreated

Failed Back Surgery Syndrome Due to Failure of Fusion Surgery

Solid fusion of adjacent vertebrae can take 3 months or longer. Spinal segments above or below fused segments are subject to increased stress and may develop new lesions or sources of pain. This is more likely to happen with fusion of more than two segments due to changes in spine mechanics.

Failed Back Surgery Syndrome Due to Failure of Decompression Surgery

Pressure may be relieved by removing bone or disc material, but the compressed nerve may take time to heal. Other symptoms such as numbness, tingling or weakness can take longer to resolve. Unresolved symptoms may suggest permanent nerve damage.

Pain may return following a period of relief in cases of recurrent stenosis or herniation. Recurrent disc herniation usually occurs in the first 3 months after surgery. Stenosis due to regrowth of bone can cause pain years after a surgery.

No relief of pain following decompression surgery may be due to:

  • Bone or disc still compressing the nerve
  • Treating the wrong spinal segment
  • Nerve damage during the procedure

Imaging studies can reveal areas of stenosis. Nerve damage and regrowth may be evaluated by EMG studies.

Failed Back Surgery Syndrome Due to Scar Tissue Formation

Following spine surgery, scar tissue usually develops as part of the healing process. It may cause fibrous adhesion of the nerve roots within the spinal canal leading to pain. This can be decreased by stretching which keeps the nerves moving to prevent adherence. Pain due to scar tissue usually develops 6-12 weeks after surgery.

Failed Back Surgery Syndrome Due to Improper Rehabilitation

Healing after back surgery can take several months to a year and postoperative rehabilitation is important. More intense rehabilitation is needed for those undergoing complicated surgery or with long-standing symptoms. Continued rehabilitation is often recommended over repeat surgery.

A treatment option that has been immensely successful with Failed back syndrome or post-laminectomy syndrome is Spinal Cord Stimulation. Your physician may discuss with you a variety of treatment options to help with your pain.