The answer is yes, but almost certainly this will be multifactorial, and affirmation does not imply that the same pain might not have arisen had the laminectomy not been performed.

It is always difficult to be specific about the exact aetiology of back pain: where there is no gold standard there is room for supposition, and there is never a shortage of that, albeit it comes clothed in certainty.

Why might a laminectomy lead to pain 20 years later?

Well the first point to make is that the laminectomy must have been performed at least 20 years ago. There was a tendency at this time to remove more bone (the lamina; hence lamin- ectomy). More recently there has been a tendency to perform much smaller operations that are less destructive to the mechanical elements of the spine. However these earlier operations often significantly disadvantaged the biomechanical functions of the posterior elements (the bony support at the back of the spine, as opposed to the disc structures at the front).

The alterations to loading of the spine leads to changes to the normal performance of the spine both in terms of additional loading as well as changes to posture and movement. These changes can cause additional stresses to the disc structure and this can produce pain. Very frequently these changes cause back pain within a year or so of the surgery but they can be delayed by many years.

Even where a microdiscectomy has been performed, back pain is not uncommon in the years following, due more to the fact that the prolapsed disc, (that led to the surgery in the first place) is abnormal and causes changes to function and loading. Thus late onset back pain may not be solely to do with the surgery, but can also be due to the disc itself which can produce pain even if surgery was not undertaken.

There can also be other contributions to pain in this scenario. These include other soft tissue problems, changes at other levels in the spine, changes to neural function within he spinal cord and brain, and local neural compression. Local scarring can contribute but is likely to have manifested itself before 20 years.