The medical term 'lamina' means 'layer', and when used in connection with the spine ('vertebral lamina') refers to the flat section of bone at the back (i.e. closest to the skin) of each vertebra which encloses and protects the spinal cord.
A laminectomy is a surgical procedure to remove the lamina on one or more vertebrae to relieve pressure on the spinal cord and / or spinal nerves, or as part of the treatment of degenerative disease affecting the spine.
The procedure is carried out to relieve back pain (and other spinal pain, such as neck pain), but in some instance patients continue to have pain after surgery – this is called post-laminectomy syndrome.
The term is sometimes used more generally to describe continuing back pain felt after any spinal surgery (e.g. spinal fusion), and is also sometimes referred to as 'Failed Back Surgery Syndrome' or 'FBSS'.
A number of things can cause the syndrome, including…
- Surgical removal of herniated disc/s - in some case a small section of the removed disc may remain or herniation of another disc can occur after this procedure; this can be almost immediately following surgery or sometime later (sometimes months or years).
- Spinal stenosis which may develop after surgery.
- Fibrosis – this is where scar tissue forms after surgery and is referred to as 'epidural post-operative fibrosis'; a variant of this, known as 'adhesive arachnoiditis' is where post-operative scarring affects a number of nerves where they exit the spinal cord.
- Nerve injury – nerve injury is a risk with any surgery and particularly with spinal surgery; nerves may be directly damaged by the surgery itself or the surgery may cause inflammation of ligaments and/or bones which puts pressure on one or more nerves in the region of the back.
- Infection – very occasionally an infection can set in after surgery.
After spinal surgery, the dynamic loading characteristics of the spine change, and facet joint pain may emerge after surgery as a result.
The primary symptom is that the pain the surgery was meant to address, continues. Other common symptoms of post-laminectomy syndrome include…
- Dull ache affecting the back and in some instances the legs as well.
- Abnormal sensations in the back, e.g. sharp stabbing pain, which may also extend to the legs.
- Although not a symptom as such, people with the condition often avoid physical activity to avoid the associated pain, which results in a decline in physical and mental health. This is generally associated with all conditions that cause chronic ongoing pain.
Tests / Diagnosis
Most tests carried out in the diagnostic process are to exclude other possible causes of the pain, such as infection, bone fracture, herniated disc/s or where previous surgery has involved the insertion of plates, screws etc. which may have loosened or broken.