Findings and outcome of revision lumbar disc surgery

One hundred fourteen patients (64 men, 50 women) with prior lumbar disc sur gery underwent a reexploration for intractable back and/or leg pain. The fi nding in revision surgery included disc herniation in 89 cases (78%), epidu ral fibrosis in 14 cases (12.2%), adhesive arachnoiditis in 4 cases (3.5%), isolated lateral spinal stenosis in 3 cases (2.6%), and iatrogenic instabi lity in 4 cases (3.5%). Review of operative reports of patients who underwe nt a first operation tin our institute revealed that seven cases (12.5%) ha d a second laminotomy without a discectomy in addition to the previous lami notomy and discectomy performed in the same session. Fifty-six of the patie nts with disc herniation in revision surgery had a true recurrence. Disc he miation was protruded in 38 cases (42.8%), extruded in 44 cases (49.4%), an d sequestrated in 7 cases (7.8%). The outcome was assessed using Prolo's fu nctional and economic scale. According to Prolo's scale, a good outcome was detected in 79 cases (69.2%), moderate in 22 (19.2%), and a poor outcome w as detected in 13 cases (11.4%). The best outcome was achieved in patients with disc hemiation. It is concluded that recurrent disc disease is the mos t important cause of reexploration. This fact dictates a careful preoperati ve workup and discectomy in the first intervention. The Likelihood of occur rence of disc herniation in the negative laminotomy level (i.e., laminotomy without discectomy procedure) also requires a careful preoperative radiolo gic workup before lumbar disc surgery.