Treatment of Postlaminectomy Syndrome with Predominantly Axial Nociceptive Lumbar Back Pain and No Radicular Component

Clinical Scenario

This protocol applies to patients with postlaminectomy syndrome whose predominant complaint is axial lumbar back pain of a nociceptive character, in the absence of predominantly radicular neuropathic pain. In this population, identifying whether the pain source is zygapophysial joint, sacroiliac joint, or disc is a necessary step before definitive treatment.

Approach

Management in this scenario begins with targeted diagnostic blockade directed at the suspected pain generator — zygapophysial joint, sacroiliac joint, or intervertebral disc. When a diagnostic procedure produces a positive response, a subsequent intervention is available for more sustained pain relief — the complete structured regimen specifies which procedures apply, in what order, and what follows a positive or negative response.

Clinical Goal

Reduction of axial lumbar back pain.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.4103/jcvjs.jcvjs_118_22

When deciding on which procedures may be efficacious in FBSS patients, it is useful to determine if the pain is predominantly axial or radicular.
For those patients with predominantly axial pain, diagnostic blockade may be performed to determine if the pain is arising from the zygapophysial joints or the sacroiliac joints.
If there is a positive response to lumbar medial branch blocks, radiofrequency rhizotomy may then be performed for longer-lasting analgesia.
For suspected discogenic pain, the clinician may consider lumbar provocation discography.

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