Causes And Radiological Findings In Failed Back Surgery Syndrome Mainly After Lumbar Discectomy.
MOHAMAD RAFAT MOHAMAD;
Abstract
The aim of the present work is to determine the underlying causes of failed back surgery syndrome, hence to find ways to prevent such a great problem with reviwing on the various methods for treatment.
Thirty patients are included in this study. All patients were subjected to proper history taking with stress on the number of previous back operations, lenghth of pain free interval and response to previous therapy, complete general and neurological examination, laboratory investigations, and radiological assessment including plain x-ray lumbosacral spine, magnetic resonance imaging MRI, computed tomography (CT) scans when indicated.
These thirty patients comprised twenty-five males and five females, with an age range of twenty to senenty-five years old with most frequent age to be affected between 50-60 years.
In this study, low back pain was the most dominant complain and was presented by 87% of patients, while unilateral sciatica was presented by 47% of cases, bilateral sciatica was a complaint of 23% of cases and cludicating sciatica demonestrated by 20% of patients.
In this study the most dominant clinical signs were back signs which were presented in all cases. Sensory manfestaions came in the second rank and were demonesterted by 63% of cases, then positive tension signs occued in 56% of cases.
The pain pattern must be carefully analyzed; in this series, the surgical candidates usually have a history of clear radicular pain, which can give an idea about the propable causation of pain.
In this study, after radiological investigations, recurrent lumbar disc herniation was the most frequent cause of failed back surgery syndrome (50% of patients), pos-tlaminectomy spondylolithesis was the second leading cause of FBSS (20% of cases), while there were other less frequent causes were demonesterated as lumbar canal stenosis, spinal infections and herniation with extensive fibrosis
Twenty-five patients were re-operated and at reoperation multiple findings were found, the most common of which was recurrent disc herniation which present in 50% of the operated cases.
Five patients managed conservatively and none of them had an excellent outcome.
Following re-operation, excellent results reached in patients having structural changes, poor results were encountered in patients with minimal radiographic findings and scare abnormalities at re-operation.
Thirty patients are included in this study. All patients were subjected to proper history taking with stress on the number of previous back operations, lenghth of pain free interval and response to previous therapy, complete general and neurological examination, laboratory investigations, and radiological assessment including plain x-ray lumbosacral spine, magnetic resonance imaging MRI, computed tomography (CT) scans when indicated.
These thirty patients comprised twenty-five males and five females, with an age range of twenty to senenty-five years old with most frequent age to be affected between 50-60 years.
In this study, low back pain was the most dominant complain and was presented by 87% of patients, while unilateral sciatica was presented by 47% of cases, bilateral sciatica was a complaint of 23% of cases and cludicating sciatica demonestrated by 20% of patients.
In this study the most dominant clinical signs were back signs which were presented in all cases. Sensory manfestaions came in the second rank and were demonesterted by 63% of cases, then positive tension signs occued in 56% of cases.
The pain pattern must be carefully analyzed; in this series, the surgical candidates usually have a history of clear radicular pain, which can give an idea about the propable causation of pain.
In this study, after radiological investigations, recurrent lumbar disc herniation was the most frequent cause of failed back surgery syndrome (50% of patients), pos-tlaminectomy spondylolithesis was the second leading cause of FBSS (20% of cases), while there were other less frequent causes were demonesterated as lumbar canal stenosis, spinal infections and herniation with extensive fibrosis
Twenty-five patients were re-operated and at reoperation multiple findings were found, the most common of which was recurrent disc herniation which present in 50% of the operated cases.
Five patients managed conservatively and none of them had an excellent outcome.
Following re-operation, excellent results reached in patients having structural changes, poor results were encountered in patients with minimal radiographic findings and scare abnormalities at re-operation.
Other data
| Title | Causes And Radiological Findings In Failed Back Surgery Syndrome Mainly After Lumbar Discectomy. | Other Titles | أسباب و نتائج الإشاعات في متلازمة إخفاق عملية الظهر بخاصة استئصال الغضروف القطني. | Authors | MOHAMAD RAFAT MOHAMAD | Issue Date | 2013 |
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