Revision Surgery for Failed Back: Techniques, Outcome, and Complications
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- Category: Vol. 81, March 2013
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Revision Surgery for Failed Back: Techniques, Outcome, and Complications,AYMAN E.A. GALHOM and MOHAMED ELHADI
Abstract
Background: Failed back surgery syndrome (FBSS) is a condition in which there is failure to improve satisfactorily after back surgery. It is characterized by intractable pain and various degrees of functional disability after lumbar spine surgery.
Object: The purpose of this study is to evaluate technique, outcome, and complication after a redo spinal surgery.
Patients and Methods: We prospectively studied 36 pa-tients with failed back surgery from October 2006 to September 2012 in Suez Canal University Hospital, Department of Neurosurgery and Orthopedic. All patients complained of either back pain, radiculopathy, claudication or a combination of these three symptoms. All patients had proper radiological examination and diagnosis before surgery. Redo surgery was targeted at correcting the underlying pathology: Removal of recurrent or residual disk, release of adhesions with neural decompression, and fusion with or without instrumentation. The patients had filled out a questionnaire that included a visual analog scale (VAS) and Oswestry low back pain dis-ability index (ODI). Questionnaire was done at baseline up to one year.
Results: The mean age was 39±11.69. History of the recurrent symptoms after previous surgeries; 30% occurred within 6 months and 50% within 2 years after primary surgery. After surgery, most of fenestration surgeries associated with disc recurrence 12/15 while most of laminectomy cases associated with instability or in adequate decompression 17/19. It was statistically significant p<0.001. Most of the recurrent discs (24/36) required no fusion or instrumentation (23/36). Instability was treated with instrumentation and fusion. Complications were limited and properly managed. Most patients (70%) attained maximum improvement at 3 months. Successful outcome (at least 80% pain relief and patient satisfaction with ODI mean score = 14.43) was obtained in 85% of the patients at 1 year.
Conclusion: The current study shows that successful management of patients with FBSS could be achieved with proper patient selection, correct preoperative diagnosis, and adequate surgical procedure targeting the underlying pathology.