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Causes of Failure of Surgery on the Lumbar Spine
437
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1981
Year
Lumbosacral RadiculopathyDegenerative Disk DiseaseLumbar SpineDegenerative SpineTreat Lateral StenosisSpinal FusionSurgeryNeurologySpine SurgeryNeuropathologyMedicineOrthopaedic SurgerySinal SurgerySurgery Syndrome
Degenerative disc disease, especially after discectomy, leads to progressive disc volume loss and bilateral lateral spinal stenosis, imposing high costs and suffering, and many failed back surgery cases could have been avoided with preventive or conservative care. The study aims to show that appropriate diagnostics and tailored surgical procedures can largely prevent failed back surgery syndrome. Stenosis was diagnosed using high‑resolution CT or intraoperative lateral canal testing, and surgeries were performed accordingly. The study found that undiagnosed or untreated lateral lumbar stenosis accounted for 57–58% of failed back surgery syndrome cases, with recurrent disc herniation and lumbosacral adhesive arachnoiditis also common causes.
An interinstitutional study on the failed back surgery syndrome (FBSS) has determined that failure to recognize or adequately treat lateral stenosis of the lumbar spine with resultant nerve irritation and/or compression comprised the primary etiology in 57% to 58% of patients. Other common causes were recurrent or persistent disk herniation and lumbosacral adhesive arachnoiditis. The diagnosis of stenosis was made either by high-resolution CT scan of the lumbar spine or by directly testing lateral canal and for animal patency at the time of surgery. It is now appreciated that the process of degenerative disk disease, particularly when enhanced by diskectomy, results in progressive loss of intervertebral disk volume and predisposes to future ipsilateral or contralateral lateral spinal stenosis. Degenerative disk disease is ultimately a bilateral process and therefore surgical exposure should be bilateral. The direct and indirect costs of FBSS to patients and to society as well as the toll in human suffering are very high. This is particularly a matter of concern when it is realized that for many FBSS patients, surgery could have been avoided in the first place by preventive care or by innovative conservative treatment. When surgery is indicated, adequate diagnostic tests and the execution of appropriate procedures based upon this information should largely prevent the failed back surgery syndrome.