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Post Laminectomy Syndrome: Addressing Failed Back Surgery

Post Laminectomy Syndrome: Addressing Failed Back Surgery
Post Laminectomy Syndrome: Addressing Failed Back Surgery

Post Laminectomy Syndrome: Addressing Failed Back Surgery

The experience of post laminectomy syndrome during back surgery has evolved considerably over the years; with the onset of high tech, minimally invasive procedures resulting in less painful and impactful procedures–and often resulting in the welcome relief of traumatic and life-altering back pain. Yet what happens when a major surgical procedure–one intended to provide a permanent and highly therapeutic escape from pain and strain–results in increased pain and discomfort? When back surgery fails, this is commonly known as “post laminectomy syndrome.”

Failed Back Surgery Syndrome

Post laminectomy syndrome, otherwise known as Failed Back Surgery Syndrome (FBSS), strikes those suffering from chronic back pain, whose attempted surgical procedures have failed to remedy or resolve the pain. Amazingly, and despite substantial innovations in the surgical arts and back surgery, in particular, the Journal of Pain Research reports that an estimated 20-40 percent of back pain patients suffer from post laminectomy syndrome.  This condition is officially 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.”4

In order to comprehend post laminectomy syndrome, one first may wish to gain a basic understanding of laminectomy; a decompression surgery intended to relieve the compression of the spinal cord or nerves through the removal of the roof or lamina above the spinal canal to decompress both sides of the canal. And while the laminectomy procedure does indeed result in post laminectomy syndrome (as, indeed, its moniker would so indicate), the condition actually results from a wide variety of back pain procedures, including the discectomy and the spinal fusion surgery.

Indeed, the general characteristics of post laminectomy syndrome can relate to any variety of spinal surgery. The condition can strike patients who underwent and recovered from spine surgery of any kind, only to develop a new, unrelated spinal condition; who underwent a spinal surgery that–while initially perceived to be successful–did not resolve the original pain; or who suffered complications from spinal surgery, including a nerve injury or infection, or a general failure to heal. Additional, exacerbating factors that can worsen this condition can include preoperative conditions such as smoking, obesity, and mental disorders such as anxiety and depression; postoperative factors that could include herniated discs and other degenerative changes; and morphed biomechanics that can result in spasms, muscular atrophy or hypertrophy, and joint leading.

Additional causes can include the incorrect diagnosis of a surgical procedure for a back pain condition; indeed, it is estimated that–from the 56 million Americans who suffer from back pain, only 5 percent are in need of surgery. Or it could be that the wrong form of surgery was prescribed for this variety of condition.  Perhaps the objective of the surgery was not ultimately attained, or the patient became afflicted with a postoperative condition (ranging from herniated discs to epidural fibrosis, spinal instability to surgical complications that could include infection, hematoma and nerve injuries, myofascial pain, etc.).

Ironically enough, many of the same symptoms that one typically associates with back pain also can be indicative of post laminectomy syndrome or failed back pain surgery; and this is perhaps the most frustrating aspect of this all too common condition. The back pain patient often undergoes surgery as a last resort; a concerted and deliberate effort to be free of the pain that necessitated the surgery in the first place. If the surgery results in increased or enhanced pain, as opposed to delivering the relief and healing that one expected in the wake of the procedure, then this is bound to result in an emotional pain that more than equals its physical counterpart–along with feelings of intense sadness and frustration.

Surgery can be a traumatic, exhausting and challenging experience; and even with all of the amazing innovations in the medical field and surgical practices in general, very few people eagerly anticipate the prospect of undergoing a major operation.

So why do about 500,000 people undergo lower back surgery every year? It’s likely because they’ve had enough. They have had enough of the pain, enough of the fatigue, enough of the strain, enough of the disruptions that are possibly hindering their work life, their family life, their lives in general. They seek a permanent, binding and effective resolution to all of that pain and discomfort; hoping that soon they will be able to return to their full and functional lives.

Yet in the instance of post laminectomy syndrome or Failed back Surgery syndrome, the relief that these patients greatly, sometimes desperately seek is eluded and denied them. They indeed even feel more pain than they did prior to their surgery; leaving them wondering if they ever will be able to walk, move, play sports, or enjoy their favorite activities as they once did.

Luckily for these people, hope and help are available for those who suffer from post laminectomy syndrome.  Today’s orthopedic physicians, utilizing all of the latest innovations in medical science, offer numerous noninvasive and minimally invasive therapies to help patients cope with and hopefully resolve this traumatic and potentially life-altering syndrome.

Before we delve into and explore these various and highly effective forms of therapy, it may first be important to address as to how one can deal with the aftereffects of a laminectomy or other back surgery; especially if these after effects involve a longer than expected or especially unproductive recovery process.

Post Laminectomy Syndrome Social Security Disability

The issue of post laminectomy syndrome and social security disability can be a pressing one for people struggling with this condition; especially if their pain and fatigue is making it difficult or perhaps completely impossible for them to work and earn a living–let alone pay their medical bills. Social security and disability benefits may be available for these people. It all depends on the severity of their post laminectomy syndrome condition, and the likelihood that their condition will improve.

In order to earn social security and disability benefits in these instances, the applicant will be required to submit medical evidence for the claim; displaying the results of a medical examination conducted by a qualified physician. Throughout the course of this exam, you likely will be asked to perform basic physical tasks; to track any physical limitations that you may be experiencing; and to verbally describe any related problems in moving, working, etc., that you are having in your day to day life. You will be asked to present the results of any X-rays, MRI’s and CAT scans taken, as well as provide a detailed written medical history of your back issues.

The duration of your issues will be considered, especially if they have been occurring for more than a year. Also considered will be your current ability to perform both basic activities, and those in which high levels of exertion are involved. Also analyzed will be the different surgeries and procedures that have been tried, and how your body reacted to these attempts at treatment.

Ultimately, a determination will be made indicating your ultimate ability to work; and if this ability is absent, then SSI and disability benefits may be rewarded.

Post Laminectomy Recovery

As you progress through this challenging time of life, any benefits you can accrue are sure to help you sustain your lifestyle and pay your bills while you focus on healing from post laminectomy syndrome. Ultimately, though, your ideal goal is to return to the active, productive life that you enjoyed before the onset of your medical issues. To this end, you may want to investigate the prospects of post laminectomy syndrome.

Throughout the diagnosis process for post laminectomy syndrome, your physician will assess the level of pain and discomfort before and after surgery, the time elapsed since the surgery, your medical history, your use of medication, the overall effectiveness of your surgical procedure, your pain patterns and issues in the wake of your surgical procedure, your current range of motion and psychical capabilities, your methods of rehabilitation, your psychological state, any activities you currently undertake in an attempt to recover and rehabilitate, your ability to work, etc.

A related physical examination will assess any pain you are experiencing, your neurological and vascular state, your joints, any fluid accumulation, your tissues, etc.

Post Laminectomy Syndrome Radiology

And as expected, post laminectomy syndrome radiology will play a crucial role in diagnosing and assessing this condition. Your physician likely will conduct X-rays, MRIs and CT scans. These radiological tests will supply a most literal clear and total picture of your internal health; and, furthermore, the role that post laminectomy syndrome may play in altering or hindering that health.

Once a thorough assessment is made for the condition of post laminectomy syndrome, then–in lieu of additional surgeries–a number of noninvasive and minimally invasive techniques will likely be attempted to resolve–or, at the very least, relieve–this serious and problematic condition.

First, a prolonged or additional period of recovery may be attempted; to ensure that sufficient time has been allowed to rebound from a laminectomy or other back surgery procedure. An extended post laminectomy recovery period does not necessarily equal a case of post laminectomy syndrome, and the physician must ensure that the patient has realistic expectations regarding the expected length of their recovery time after surgery. And most importantly of all, they must not rush to schedule an immediate, possibly drastic follow-up surgery.

The person might be advised to rest up and abstain from strenuous or arduous activity, and might be instructed as to new and safer ways to move and conduct everyday physical and work-related activities. This period of physical re-education and reorientation (accompanied by a regimen of psychological therapy that includes relaxation, visualization, emotional rejuvenation, setting life and fitness goals, etc.) may help to both hasten and facilitate the recovery process.  Additional medication might be prescribed, in the form of Acetaminophen, Nonsteroidal anti-inflammatory drugs (NSAIDs), Cyclooxygenase-2 (COX-2) inhibitors, Tramadol, Muscle relaxants, Antidepressants, Gabapentinoids, and Opioids.

Post Laminectomy Syndrome Physcial Therapy

If these means and methods prove ineffective, then the patient is in all likelihood afflicted with post laminectomy syndrome; and at this point, the diagnostic code of post laminectomy syndrome and 10 likely will be applied to the case–a code recognized throughout the medical community, that is useful for insurance and reimbursement purposes.

Yet again, surgery is not the ultimate or ideal answer to this condition. Indeed, the attending physician might suggest a regimen of low-impact therapeutic exercise to help deal with post laminectomy syndrome. This regimen could very well focus on aerobics, flexibility maneuvers, strengthening exercises, body mechanics, etc. Other forms of physical therapy may be prescribed, with the kind and variety depending entirely on the preferences and capabilities of the patient and the doctor’s recommendations.

All exercises prescribed should succeed in alleviating pain, enhancing fitness levels, alleviating any and all stress on the spine, straightening posture, strengthening the muscles and stabilizing the spine. As an added bonus, a steady regime of physical activity tends to lift the spirits and brighten one’s psychological outlook as well.

Even for the seasoned fitness enthusiast, someone who has undergone major back surgery should not be tackling advanced weight training or high-velocity dancerersize at this stage of the game. A sound and effective fitness program for post laminectomy syndrome could consist of strengthening, stretching and core strengthening; low impact but nonetheless highly empowering and therapeutic exercise methods that will with all hopes alleviate and perhaps even remedy the symptoms and condition of post laminectomy syndrome.

While rest and relaxation are indeed important for any back pain sufferer, regardless as to whether or not they have undergone surgery or the overall success of that procedure, it is also important for the patient to get and stay active; to get back into the groove of life as quickly and as thoroughly as possible, to both heal and build their backs and bodies as they try to overcome their instance of post laminectomy syndrome and get back on the road to recovery. At the same time, they must be careful not to overshoot or overexert in their effort to remain active.

Acupuncture For Post Laminectomy Syndrome

As might be expected, not all suggested methods of dealing with post laminectomy syndrome are active and physically strenuous in nature. A relaxing prescription of therapeutic back massage, spine manipulation, and acupuncture is also advised.

Indeed, acupuncture for post laminectomy syndrome is a widely used and highly effective means of coping with this and many other physiological conditions. Drawing its origins from ancient China, acupuncture involves the strategic application of needles (although modern physicians also apply manual acupuncture with their fingers and computerized acupuncture via high tech guided needles) to pressure points in the afflicted areas; channeling and correcting imbalances in energy in an effort to relax the patient and combat any and all pain.

The National Institute of Health has recommended acupuncture as a possible therapy for low back pain; so it only stands to reason that this time-honored healing method also might prove effective in combating and relieving the effects of post laminectomy syndrome.

Injections are another form of medicinal therapy that is used to heal and aid victims of post laminectomy syndrome. To be more specific, lumbar spinal epidural injections have been judged to be particularly effective in supplying short-term pain relief for lower back pain; and also has been known to provide a certain, variable degree of pain relief in the long run. A trusted pain remedy since the early 1950s, these injections can be used in tandem with a comprehensive therapy program to help resolve an instance of post laminectomy syndrome

If these options prove inadequate in remedying or resolving post laminectomy syndrome, then surgery may be advisable to finally cure an instance of FBSS. In this instance especially, surgery always should be considered as a last resort; and always should be a minimally invasive procedure with few complications, conducive to improved and enhanced bodily function; a swift and expedient return to work; and a quick and substantial improvement in gait and muscle strength. It should always be kept in mind, furthermore, that the success rate for revision or reoperative surgery tends to decline with each procedure.

And while lumbar decompression and spinal fusion are indeed surgical options available to sufferers of post laminectomy syndrome, one of the leading spine surgeries currently in practice is spinal cord stimulation; a surgical technique that involves the insertion of electrodes into the cervical or thoracic spine. Physio-pedia.Com reports that “Probably the most important aspect of the decision for reoperation is for consultation with an expert spine surgeon with experience with FBSS.” [1]

Dr. Payam Moazzaz of New Era Spine is a leader in the field of orthopedic spine surgery; counting among his specialties the successful treatment of post laminectomy syndrome and failed back surgery syndrome.

Through his decade’s worth of experience in the orthopedic field, Dr. Moazzaz has become an expert in the area of minimally invasive surgery and its high tech subset, robotic spine surgery. He ranked among the first surgeons to perform robotic spine surgery via a first-generation platform that garnered FDA approval in 2011; and he stands among the first physicians to make use of a robotic spine surgery platform called Mazor X,  a platform introduced nationally in 2016. This revolutionary evolution in surgical technology has been used in more than 120,000 surgical procedures around the world, including a good number of post laminectomy syndrome surgeries.

Dr. Moazzaz has performed more than 500 spine surgeries using robotic technology with 100% accuracy, which is the most robotic spine surgeries in the State of California.

This form of surgery is minimally invasive in nature, featuring fewer incisions, less time spent in the surgery and recovery rooms, and less pain and discomfort. This is a particularly important consideration among those who cope with post laminectomy syndrome, as they already have spent a great deal of time in operation and waiting rooms.

Robotic spine surgery, a surgical procedure that applies futuristic computer-driven technology to the medical issues and conditions of today, is perhaps the most technologically revolutionary and progressive of post laminectomy syndrome surgery procedures; and certainly one that offers new help and hope for patients of post laminectomy syndrome and failed back surgery syndrome.

The ‘robots’ at work in this brand of advanced post laminectomy syndrome surgery take the form of compact and highly efficient medical equipment. It saves time, anxiety and discomfort for the post laminectomy syndrome patient, who already has accumulated quite enough of all three, and tends to deliver optimum and long lasting results; even when it comes to a condition such as this one, which traditionally has proven a challenge to diagnose and resolve.

This new and very exciting brand of post laminectomy syndrome treatment comes complete with a revolutionary brand of surgical procedure; one that commences days prior to the actual operation.

The process involved with this variety of post laminectomy syndrome begins several days preceding the actual procedure when images are taken of the patient to cultivate a three-dimensional image of the spine; an image used as a blueprint for the post laminectomy syndrome surgery, pinpointing the particular areas that require the surgeon’s attention.

This advanced, minimally invasive type of post laminectomy syndrome surgery spares the failed back surgery patient from the poking and prodding that generally takes place through the process of conventional surgery. Armed with their intricate and highly detailed three-dimensional images, the surgeon inserts miniature surgical instruments through smaller incisions by way of robotic arms; permitting the doctor an unrivaled range of motion and precision.

In this variety of post laminectomy syndrome surgery, a high-definition, three-dimensional camera guides the surgeon through the surgical procedure by way of a computerized monitor and console; and by accessing this literal inside view of the patient’s back, the surgeon performs every move of the surgery with the able assistance of their robotic counterpart.

The patient likely will experience a less painful surgical procedure, one entailing a smaller quantity of blood loss, fewer complications, and a much faster return to normal activities via a far more abbreviated post laminectomy syndrome surgery recovery time.

Among the most painful and frustrating of orthopedic conditions, post laminectomy syndrome is sometimes difficult to diagnose and even tougher to resolve. Yet thanks to new and innovative medical technology, you can finally get the subject of FBSS ‘off your back.’

Contact Dr. Payam Moazzaz and New Era Spine today to arrange a consultation on the subject of robotic spine surgery and post laminectomy surgery.