脊椎および脳神経外科ジャーナル

Clinical Outcome in Reoperation Following Lumbar Spine Surgery: A Single Surgeon’s Experience of 231 Patients

Ghassan Skaf, Elias E, Nasser Z, Haddad G

Objective: Failed back surgery syndrome is a situation of expectation failure after a lumbar spine operation. It is described as continuous or new onset pain post initial surgery; associated with functional disability; affecting daily life activities. Main reasons for FBSS are fibrosis; recurrent disc herniation and spinal instability. Our aim is to identify the proper patient to undergo reoperation as the best treatment modality embodied by the Oswestry Disability Index. Methods: We retrospectively reviewed charts for 231 patients who presented with symptoms and signs of FBSS. Most subjects had at least one previous lumbar surgery at an outside hospital and presented within 3 months period after their last intervention. Radiographs identified the anatomical cause of the patient’s complaints. Post-surgical outcome was assessed using the ODI; by following patients up to 1 year from their latest revision surgery. Results: Successful outcome characterized by more than 50% pain relief (50 percent reduction in mean ODI) was attained at 90 days. Improvement was achieved in 87 % of our population. Mean ODI score was 83.15 pre-operatively and reached 25.38 after our surgical intervention. Moreover; negative correlation between outcome and risk factors were also reported with rate of complications; female gender and elderly age. Conclusion: This study reveals a high success rate of revision spinal surgery. We recommend performing spinal fusion; careful patient selection and proper diagnosis prior to operation. Aiming for precise pathology of failed back surgery syndrome is vital in achieving satisfactory results with redo-operations.