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Post-laminectomy Syndrome: Causes, symptoms, treatment, and important queries

Laminectomy is the procedure that is performed by a surgeon for relieving the pressure that exists in the spinal cord while Post-laminectomy syndrome is the condition in which people suffer central neck or back pain persistently after the surgery. In this context, you will find out about what etiology may cause post-laminectomy syndrome. Additionally, this content helps you to learn about their signs and symptoms, its treatment, how you can prepare yourself for a laminectomy, and what would happen after the laminectomy. 

Overview

Post laminectomy syndrome is the condition in which a patient is suffering from back pain after the surgery or may experience some spinal injuries. People who may experience this laminectomy syndrome persistently suffer distress, pain with continually exacerbating pressure, while laminectomy is the procedure that is performed for relieving the pressure, and the distress of spinal cord. Your consulted surgeon removes the lamina (part of the vertebral bone) that helps to relieve spinal cord or nerve root pressure that is mostly caused by any tumor, spinal stenosis, and injury. Most of the patients recover successfully without experiencing any complication, whereas some patients experience back pain, and rarely, pain in legs. This lasting pain is known as laminectomy syndrome. 

Post-laminectomy syndrome is also known as Failed Back surgery syndrome. 

Causes of the post-laminectomy syndrome

There are numerous causes in patients that are developing back pain following laminectomy. The main cause of the post-laminectomy syndrome is when the patients have suffered surgery of the lumbar spine or spinal cord at least once or more than one time, and then they experience persistent pain in their back. This back pain is divided into two groups. 

  • First group: The first group includes patients who have not indicated surgery or they operate but this surgery decision does not give any positive result; alternatively, they have indicated surgery but due to technical issues the surgery is not getting the intended result.
  • Second group: The second group of the post-laminectomy syndrome includes the patients who suffered inadequate surgery and they have spinal stenosis (the spinal cord becomes narrow) in which they may suffer from the pain or distress. Even though in most of the cases, fragments of the disc remain that become the cause of spinal cord irritation, the discomfort that may result in back pain. This inadequate exposure of surgery may lead to other issues that have actually not any underlying pathology. The patient who experienced failed surgery, they are, most likely having a higher risk of post-laminectomy syndrome. 

 The other causes include nerve injuries, postoperative fibrosis, post-operative infections, and persistent distress.

Signs and symptoms of post-laminectomy syndrome

Mostly back pain is common and it is found in every second person due to multiple causes. Most people do not take it seriously and they don’t have any idea why the low back or neck pain exists continually. However, this is the main symptom of post-laminectomy syndrome.

This back pain and pain in extremities is occurred due to many possibilities these are:

  • Arthritis (joint inflammation) of spinal joints
  • Spasm of muscles due to any trauma, injury, or poor muscles condition
  • Any instrumentation that becomes the cause of pain (such as the use of metal for secured spinal fusion)
  • Surgical complications 
  • Bleeding or any infections
  • Complain of neurological symptoms (such as heat, electricity, cold)
  • Nerve injuries
  • Dysfunction of the bladder (less common symptom)

How can you prepare yourself for laminectomy?

  • Whenever you decide to do laminectomy, then your physician or surgeon explains the entire procedure and clarifies all your queries regarding surgery.
  • If you agree for surgery then the doctor starts to examine your condition and start doing your complete health checkup to know whether your health is good for the procedure or not. Then they also perform some diagnostic tests to check your blood count, allergic reaction, Hb, and so on.
  • If you have any medicine allergy, tape, latex, sensitivity, then you should tell your doctor.
  • You should tell your doctor if you intake any medicine, food supplement, or herbal medicines, or any anticoagulant medicine (such as aspirin). Might be possible that the doctor stops all your intake of dosages if they have any other plan for your health.
  • You should also tell your doctor if you have any history of diseases (such as diabetes, asthma, bleeding disorder).
  • You should also tell the doctor if you are pregnant or expected soon. 
  • Then your health care provider signs a consent form you and your attendant which clearly mentions that you are giving permission to do the surgery after reading it carefully. 
  • The doctor gives you a list of instructions that you need to follow before the surgery and they also guide you that you are not drinking or eating before the surgery.
  • After that, your doctor sedates you for giving you relaxation and continually monitors vitals.
  • Your surgeon also fixes a meeting with the physical therapist before the surgery that guides or discusses the rehabilitation plan.
  • After the surgery, the doctor restricts some activities for you (such as immobilization, food restriction) and also monitors or evaluates all vitals, signs, and symptoms whether you are in a good condition or not.
  • Once you recover successfully, then the doctor makes a decision to discharge you with a lengthy list of instructions and guidance.

What happens during laminectomy?

The laminectomy procedure is done with general anesthesia and it usually requires a hospital stay or it may also vary according to the patient’s condition. Additionally, laminectomy is also done when you are awake by giving spinal anesthesia. By giving spinal anesthesia you have no or less feeling from your waist. More advanced techniques are now being introduced in the medical line that allows doing the procedure with local anesthesia. Your surgeon discusses the entire thing in advance with you. The laminectomy procedure follows this process:

  • The Healthcare provider tells you to remove the clothes and wear the gown during the procedure.
  • Intravenous (IV) lines are maintained in your hand or arm.
  • Then the healthcare provider gave you anesthesia that would be decided in advance and then inserted in the urinary drainage catheter.
  • Now the healthcare provider removes the hair, if present at surgical sight.
  • The doctor or health care provider gives you a position on the operating table and cleans the site of surgery with an antiseptic solution.
  • At that time, the anesthesiologist persistently monitors the blood pressure, heart rate, oxygen saturation during the time of surgery.
  • Now the surgeon makes an incision at the chosen site of the vertebra and they spread the muscles.
  • The surgeon detached the lamina (bony arch) at the posterior side of the vertebra for relieving the nerve pressure. Your surgeon also removes bone spurs and all disk parts.
  • Then the surgeon does spinal fusion in which they connect the two or more bones in the spine.
  • After doing all procedures successfully, surgeons close the incision with the help of stitches, while surgical staples are also used to close the incision.
  • At last, the health care provider applies a sterile bandage or dressing on the incision part. 

What would happen after a laminectomy?

After the laminectomy, you should take care of yourself. Generally, there are two steps that will be done after a laminectomy that include:

1. When you are in the Hospital

After the laminectomy, your doctor shifts you in the observation room to evaluate you. Once you recover successfully and your doctor informs you that your blood pressure, heart rate, breathing rate, oxygen saturation, and pulse are in stable condition then they decide to shift you to the hospital room because laminectomy is the procedure that requires a hospital stay for one or more days to recover. 

Your doctor suggests you to get-up from the bed and start walking and they also control the pain with the help of painkillers or medicines. Then the physical therapist suggests some exercise to do in-hospital stay and after the discharge also.

2. When you are at home

After the discharge when you are at your home, the main thing is to clean the surgical site and prevent it from dirt and infections. At the time of discharge, the doctor also guides you on how you can take a bath by following some instructions. They also guide you and restrict you to take the medicine at regular time intervals that are giving you relief from soreness and pain. The doctor also tells you when you come to the hospital for a follow-up. 

When to go to your doctor?

After the discharge at the hospital, you should visit your doctor for a follow-up. But you should be concerned with your doctor if you have any of the following:

  • High temperature (fever)
  • Swelling or redness
  • Bleeding or any other drainage at the site of incision
  • Numbness
  • Problem in urination, or find troubling in bladder or bowel control

These are all the conditions in which you should be immediately concerned with the doctor and besides this, you also restrict yourself from driving if you are not feeling well or haven’t recovered properly. Additionally don’t pick heavy objects that cause discomfort.

Why does back surgery fail?

Generally, there are many possibilities that failed the back surgery and they are not giving the desired results. The most common cause of the failed surgery is spinal nerve damage in which the surgery or procedure did not give good results or help to recover from any injuries, trauma. 

Even though another cause is scar formation in which the body is trying to heal itself, there is the possibility that your body behaves negatively or gives negative reactions, or also cause spinal fusion. 

How is post-laminectomy syndrome diagnosed?

Whenever patients are suffering from pain so they can also experience many difficulties to perform daily life activities and they visit the doctor while complaining about pain in the back or neck or more symptoms. To diagnose post-laminectomy syndrome your doctor examines you completely and asks if they feel pain at the site of the surgery or not. Your doctor also diagnoses this syndrome on the basis of your walking position and your varied postures. But when the history-taking or examination is not adequate to diagnose the post-laminectomy syndrome so your doctor prescribes some imaginary test for making correct diagnoses such as X-rays, Ct scan, and MRI. This imaginary test helps your doctor to visualize any infections, scar formation, damaging of nerves, and formation of an abscess.

How is post-laminectomy syndrome treated?

To treat central neck pain or back pain, most treatments are introduced to improve the patient’s condition. The first priority is to evaluate the patient properly and also judge the severity of the pain. The examination includes a detailed history of the patient, and then on the basis of the examination, your doctor prescribes you a variety of treatments. These are:

1. Painkillers

Painkillers are considered as first-line defense treatment to treat post-laminectomy syndrome that is recommended by the doctor. Doctors mostly prescribe morphine-based painkillers to treat the post-laminectomy syndrome. Even though the doctor monitors or evaluates you continuously to avoid the dependency of opioids. 

2. Physical Therapy

The physical therapist recommends some exercises along with pain killers. Exercise helps you to relieve pain and give strength to the joints or bones. It also provides you with electrical stimulation that helps to reduce the pain and improve the movements and stability.

3. Specialist Therapy

If the painkillers and physical therapies are not working effectively and not giving better results then your doctor refers you more advanced special therapies. This therapy includes: 

  1. Epidural Nerve Block: Epidural injection is injected in epidural space (which is the outer space of spinal canals) that is introduced by your doctor for freedom of the back or neck pain. Generally, three injections are introduced or it may be injected into the patient. This injection gives relief after one or two.
  2. Radiofrequency Denervation: This is the invasive procedure that your doctor recommends to treat the back or central neck pain. In this procedure, a needle is inserted into the back after giving local anesthesia. In radiofrequency denervation, the tip of the needle is heated to destroy the nerve endings. The basic goal of radiofrequency denervation is to stop the pain signals that exist in nerves and sends in the brain.
  3. Platelet Rich Plasma Therapy: The platelets rich plasma therapy is introduced for healing and decreasing the inflammation. 

Before you leave!

Post-laminectomy is the syndrome in which a patient suffers central neck pain and back pain after experiencing surgery. Post-laminectomy syndrome is often caused by a number of reasons. The most common cause of the post-laminectomy syndrome is when the patients are experiencing lumbar or spinal surgery at least once or more than one time with undesirable results, while it may be caused by the narrowing of the spinal. The symptoms appear as pain, discomfort, and nerve injuries, bleeding, trauma, or infections. But hopefully, it can be treated easily. Your doctor prescribes you the treatment after examining and it may depend on the severity of the syndrome. The treatments are included as painkillers or physical therapy. If it is not treated properly with this treatment then your doctor goes to another advanced special therapy to give you comfort. 

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