THE FAILED BACK SURGERY SYNDROME - REASONS, INTRAOPERATIVE FINDINGS, AND LONG-TERM RESULTS - A REPORT OF 182 OPERATIVE TREATMENTS

Study Design. A retrospective study was performed of 182 revisions On failed back surgery syndrome from the years 1965 to 1990. Objective. T o analyze the reasons for failure of primary discectomy, the outcome o f the revisions, and factors that influenced those outcomes. Summary o f Background Data. The reported reintervention rates after lumbar disc ectomy range from 5% to 33% depending on the type of surgical procedur e. The authors' former investigations reported a revision rate of 10.8 % in evaluating 1500 lumbar discectomies. Methods. Because the documen tation was standardized, detailed data of all patients were available. To gain further information concerning the long-term results a questi onnaire was used. Computer processing and statistical tests were perfo rmed. Results. One hundred eighty-two revisions were performed on 136 patients. Forty-four patients (34%) were revised multiple times. Gener ally, recurrent or uninfluenced sciatic pain-and neurologic deficiency or lumbar instability led to reintervention. Recurrent lumbar disc he rniation mainly was found at the first reintervention. In multiple rev ision patients the rate of epidural fibrosis and instability increased to greater than 60%. In 80% of the patients the results were satisfac tory in short-term evaluation, decreasing to 22% in long-term follow u p (2-27 years). Conclusions. Laminectomy performed in primary surgery could be detected as the only factor leading to a higher rate of revis ions. A trend toward poor results after recurrent disc surgery seems t o be fateful because of the development of epidural fibrosis and insta bility. In severe discotomy syndrome, a spinal fusion seems to be more successful than multiple fibrinolyses.