Post-Laminectomy Syndrome: Chiropractor Viewpoint

Laminectomy Video

The patient is suffering symptomatically and beginning to be further restricted functionally but the nerve roots do not seem to be in peril at this time. He has back and leg pain, settling of the facets with the disc narrowing and significant degenerative disease. A lot of information is lacking. What is the type of conservative care he has received? Can the pain generator be more clearly delineated diagnostically?

With pain on flexion and extension an examination of facet joint function is in order. If provocative movement and pressure to the facet joints evokes the patient’s pain and there is evidence of local joint restriction, then a trial of continuous passive motion and high velocity, low amplitude (HVLA) spinal manipulation may prove useful. If manipulation has been a part of the earlier conservative care or symptom relief is only temporary but facet disease seems clinically evident, then facet injection followed during the analgesic period (manipulation under joint analgesia) may provide more long term relief by permitting more complete mobilization of the joint.

Degenerative disease with disc settling increases stress in the facet articulations. Clinical experience and research including cohorts with chronic pain suggest that painful articulations benefit from increased movement. Biomechanically, continuous passive motion and HVLA has been shown to decrease pain and increase function. The individualistic patient response and the extent of pathology will limit the final outcome. State of the art requires an appropriate trial (2 to 4 weeks) of therapy to determine the prognosis.

• Article written By:
• John J. Triano, DC, PhD

December 14, 2000

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