Evaluation & Diagnosis
Appropriate management of this often-debilitating diagnosis is dependent on a thorough and systematic evaluation of potential pain generating structures. This is particularly true in patients whose history is made even more complex by prior surgery. In-depth evaluation of post-laminectomy syndrome may routinely include any combination of studies such as contrast enhanced MRIs, flexion-extension x-rays, nerve conduction/EMG studies or fluoro-guided diagnostic spinal injections. Using a combination of these studies is necessary to better localize abnormal structures that are commonly responsible for generating the post-surgical pain pattern.
Correctible Causes
Typically correctible causes of post-operative spine or leg pain may include recurrent or new disc herniation, retained disc fragments, incomplete decompression surgery (as seen in far lateral stenosis), post-operative spinal or pelvic ligamentous instability (such as SI joint dysfunction), scar formation (i.e. arachnoiditis or epidural fibrosis), and recurrent myofascial pain. When accurately diagnosed, many of these painful conditions can be effectively managed with a broad array of non-surgical approaches.
Treatment Options
Just as each post-laminectomy patient is unique, so too is each conservative treatment protocol. Commonly employed tools may include comprehensive on-site physical therapy with spinal stabilization exercises and modalities, medication management including NSAIDs, membrane-stabilizers, anti-depressants and appropriately prescribed opioid regimens, injection therapy including selective nerve root blocks, epidural injections or proliferant therapy, pulsed radiofrequency deactivation of dorsal root ganglion, and lysis of adhesions.
Despite many advances in surgical techniques, post-laminectomy pain continues to be a relatively common occurrence. Our physicians believe that in order to effectively manage this pain, it is essential to first accurately identify its cause. Using state-of-the-art diagnostic and treatment techniques, many patients can go on to lead productive and pain-controlled lives.