P. Guigui et al., REVISION SURGERY FOLLOWING SURGICAL-TREAT MENT OF LUMBAR SPINAL STENOSIS, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 81(8), 1995, pp. 663-671
Purpose the study The aim of this study was to determine the causes of
failure following surgical treatment of lumbar spinal stenosis, indic
ations for redo surgery and factors influencing the final result. Mate
rial and methods Between 1975 and 1992, 38 patients were reoperated af
ter a surgical treatment of lumbar spinal stenosis. The mean follow-up
was 34 months. All of these patients had had at least one previous lu
mbar spinal operation. Second operation was performed 35 months on ave
rage following the previous surgery. Clinical evaluation : the grading
scale used in this review assessed walking ability, radicular pain at
rest and at exersion, back pain, motor deficit and sphincter dysfunct
ion. Patients were evaluated before and after the 2 surgeries and at l
ast follow-up. Radiological study was done from CT-scan, MRI, myelogra
ms, static and dynamic standard X-rays before the first surgery and fo
llowing the revision surgery. Results and discussion According to our
grading scale the final result was very good for 36 per cent of the pa
tients, good for 24 per cent, fair for 24 per cent and poor for 16 per
cent. The main causes of failure were post-operative destabilization
and incomplete neurological decompression. In 56 per cent of our cases
initial nerve roots decompression was incomplete: disc excision witho
ut bone resection in case of lumbar stenosis associated with disc hern
iation, incomplete lateral release, decompression of the symptomatic n
erve roots only and not of all of them that were compressed. In these
cases revision surgery was comprised by a new decompression. In 25 per
cent of our cases post-operative destabilization was the cause of fai
lure. During the previous surgery bone resection had been extensive :
total bilateral facetectomy without fusion, wide laminectomy extended
into the pars inter-articularis, resulting in isthmic fracture. Revisi
on surgery was a posterolateral fusion with or without instrumentation
generally associated with a new decompression. Two patients were reop
erated on without evidence of inadequate decompression or destabilizat
ion. Result was poor in both. Final results were statistically better
when the cause of revision surgery was a post-operative destabilizatio
n and when redo surgery was performed on surgically untouched levels.
Conclusion Final results were disappointed since only 60 per cent were
good or very good results. Revision surgery should be avoided, by usi
ng pre-operative planning of the neural decompression; and by adding a
fusion if a wide bone resection is necessary.