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The term “post lumbar laminectomy syndrome” has evolved over the years. Various terms, including “Anterior lumbar fusion” and “Bilateral laminotomy,” have been used to describe this condition. The article also discusses the terminology of spinal fusion and “Bilateral laminotomy.”
Changing terminology for post lumbar laminectomy syndrome
There is a growing concern about the use of the term post-lumbar laminectomy syndrome, or PLL, as it may cause more confusion than it solves. This syndrome is caused by the removal of a portion or entire lamina, which covers the spinal canal. A laminectomy surgery relieves pressure on the nerve roots by removing a section of the lamina, which is made of bony tissue that lines the back of the vertebrae. Herniated discs are often accessed through a decompressive procedure.
Post laminectomy syndrome is also known as failed back syndrome, and can lead to various symptoms. A doctor is the only person who can properly diagnose the condition and provide appropriate treatment. While the condition may look similar, it could be a complication of the surgery, or it may be a new problem caused by the laminectomy. Proper diagnosis will help you get the best treatment possible.
Post Lumbar Laminectomy Syndrome
Radiographic changes in early degenerative disc disease
Postoperative changes in MRI are related to the severity of early degenerative disc disease. Patients who have a pain-free 6 months postoperatively are considered asymptomatic. However, recurrent disc herniation is possible, and the incidence of this condition varies from three to 18 percent. In early degenerative disc disease, MR imaging with contrast is preferred because of its superior contrast resolution. Contrast administration also allows a clear distinction between recurrent disc herniation and peridural fibrosis. However, delayed postcontrast imaging should be avoided in the postoperative spine, since contrast can diffuse into disc material.
The pathogenesis of these changes is biomechanically related. Radiologists who understand this process are able to anticipate the development of further abnormalities. It is possible to identify hidden abnormalities and find the root causes of pain and neurological symptoms. Therefore, radiologists need to have a comprehensive understanding of degenerative disc disease to accurately diagnose and treat patients. This article discusses radiographic changes in early degenerative disc disease after lumbar laminectomy
Bilateral laminotomy
During a laminectomy, the affected vertebrae are divided in two. One of the vertebrae is removed while the other remains intact. The surgical procedure may also involve spinal fusion, which connects 2 or more vertebrae in the spine. After the surgery, the incision is closed with stitches or surgical staples. Afterward, the patient is taken to a recovery room where a sterile bandage is applied to the wound. A sedation drug is administered. The patient may also be given a urinary drainage catheter. The surgical site will be shaved, and any hair may be removed from the area.
Surgical treatment depends on the extent of the symptoms. In mild cases, laminectomy may not be necessary. However, if symptoms of post-lumbar laminectomy syndrome become more severe, the patient may need surgical intervention to relieve the pain and restore mobility. Surgical goals include decompression of all compressed levels and stabilization by solid fusion. The techniques used vary from one patient to the next. In some cases, decompression laminoplasty without fusion may be used.
Post Lumbar Laminectomy Syndrome
Anterior lumbar fusion
The outcomes of anterior lumbar fusion for post lumbosacral degeneration are comparable to those seen with decompression alone. However, the clinical benefit favoring fusion diminished when the analysis was restricted to patients with neurologic symptoms. Furthermore, the use of adjunctive instrumentation increased the probability of solid fusion, but did not improve clinical outcome. While the results are inconclusive, spinal fusion is correlated with a lower rate of reoperation and fewer complications than decompression alone.
The use of fusion surgery is not advisable in patients with post-lumbar laminectomy syndrome. The AANS/CNS guidelines for the procedure address the methodological issues of guideline formation, the effects of fusion surgery on patients, and specific populations. The use of pedicle screws, bone graft substitutes, and intraoperative monitoring are all discussed as adjunctive procedures.
Intensive interdisciplinary rehabilitation
Intensive interdisciplinary rehabilitation for post-lumbar laminectomy syndrome is a promising therapeutic modality for the management of post-lumbar laminectomy syndrome pain, with positive outcomes. Patients improve in functional status and self-efficacy through this therapy, which decreases pain levels. This treatment is effective for patients who have had unsuccessful spinal cord stimulation.
The guideline recommends the use of intensive interdisciplinary rehabilitation (IIR) as a complementary treatment to surgery. Non-surgical therapies are associated with small to moderate benefits. However, the majority of patients do not achieve an optimal outcome, which is defined as no or minimal pain, returning to full function, and discontinuing medications. It is important to note that there are several disadvantages associated with non-surgical treatments, including the high risk of complications and the need for frequent re-operation.
