Risk Factors Of Failed Back Surgery Syndrome Following Open Posterior Lumbar Surgery For Degenerative Lumbar Disease

Objective:The aim of this study was to investigate the incidence and risk factors of failed back surgery syndrome(FBSS)following open posterior lumbar surgery for degenerative lumbar disease.Method:The medical records of inpatients who underwent open posterior lumbar surgery due to degenerative lumbar disease from January 2018 to August 2020 were retrieved from the Department of Spine Surgery of China-Japan Union Hospital of Jilin University.According to the report of the validated North American Spine Society(NASS)Questionnaire,patients were divided into two groups: FBSS group and non(N)-PLBP group.Reasons for dissatisfaction with surgery were recorded.To explore risk factors for FBSS,the following factors were analyzed statistically.Patient characteristics: age,gender,hypertension,diabetes mellitus,long-term analgesic use and diagnosis.Symptom characteristics: symptom location,duration,aggravation,intermittent claudication.Surgical variables: surgery time,surgical strategy,the number of surgical levels and postoperative rehabilitation.Radiographic parameters: preoperative lumbar lordosis(LL),preoperative segmental lordosis(SL),high intensity zone(HIZ)and Modic changes.Clinical outcomes were evaluated using pain Numerical Rating Scale(NRS).Covariate selection for the multivariate analysis was based on P value <0.05 in univariate analysis,with a binary logistic regression model and a backward elimination procedure.Each variable’s odds ratio(OR)with 95% confidence interval(CI)was recorded.All statistical analyses were performed using SPSS version26.0 software(IBM,USA).Result:A total of 333 consecutive patients underwent open posterior lumbar surgery were included in the retrospective cohort study.Of these,16.8% were classified as FBSS.Univariate analysis showed that age,hypertension,symptom location,intermittent claudication,preoperative pain NRS(leg),HIZ,Modic changes,surgical strategy and postoperative rehabilitation were related to FBSS.Multivariate logistic regression analysis demonstrated that preoperative pain NRS(leg)(OR:0.80,95%CI:0.71-0.91,P=0.001),hypertension(OR: 2.22,95%CI: 1.10-4.51,P=0.027),intermittent claudication with waking distance >100m(OR: 4.07,95%CI: 1.75-9.47,P=0.001),intermittent claudication with waking distance ≤100m(OR: 12.43,95%CI: 5.54-27.92,P<0.001),HIZ(OR: 8.26,95%CI: 4.00-17.04,P<0.001),Modic changes(OR: 3.41,95%CI: 1.73-6.71,P<0.001),postoperative rehabilitation(OR: 2.63,95%CI: 1.13-6.12,P=0.024)were independent risk factors for FBSS.Conclusion:Open posterior lumbar surgery was an effective treatment for degenerative lumbar disease which provided pain reduction and lumbar curve improvement with a considerable satisfaction rate.Lower preoperative pain NRS(leg),hypertension,intermittent claudication,HIZ,Modic changes and postoperative rehabilitation were independent risk factors for FBSS.These factors can serve as a tool for clinician to identify at-risk populations that need more effective management to mitigate the doctor-patient contradicts and further occupation of medical resources.