Failed Back Surgery Syndrome: Evaluation of 100 Cases
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- Category: Vol. 78, March 2010
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Failed Back Surgery Syndrome: Evaluation of 100 Cases,MOHAMAD H. EL-SISSY, MOHAMAD M. ABDIN and AMR M.S. ABDEL-MEGUID
Abstract
Background: Failed back surgery syndrome is a clinical syndrome of failure of long-term improvement after back surgery. It is a frequent condition with an incidence 5-50%. It is characterized by persistent back and/or leg pain after one or more lumbosacral spinal surgery. The most important causes of this syndrome are: Recurrent herniated disc, perineural fibrosis, spinal stenosis, spinal instability, inadequate decom-pression, infection or wrong diagnosis. The purpose of this study is to evaluate the outcome after spinal surgery and the possible etiology of failed back surgery to minimize the incidence of such condition.
Methods: The medical charts of 100 patients with failed back surgery syndrome in the interval from January 2006 to May 2009 were evaluated. The analyzed factors included were: Age, gender, pain-free interval, etiology and clinical picture with radiographic assessment.
Results: In this study the incidence of failed back syndrome was 28.7%. Analysis of offending etiology reveals: Recurrent disc herniation in 18.6% of cases, perineural fibrosis in 32% of cases, spinal stenosis and instability in 18% of cases for each, missed level of pathology in 5% of cases, discitis in 4% of cases and arachnoiditis in 1 %, the etiology was unknown in 4% of cases. All cases of failed back syndrome had back pain and 79 cases had lower limb pain. The pain-free interval was average 7 months. The incidence of this syndrome was higher in males (36.8%) than in females (17.7%) with no specific age distribution. Finally the use of microsurgery did not alter much the incidence of failed surgery, in microdiscec-tomy the incidence of failure was 26.4% while in open dis-cectomy it was 29.4%.
Conclusion: The failed back surgery syndrome remains a challenge for all spinal surgeons. Prevention of such syn-drome is much easier than being confronted with it, this can be achieved by: Proper patient selection for primary surgery, correct preoperative diagnosis and adequate surgical procedures targeting the pathology.