The Analysis Of Etiologies Of Failed Back Surgery Syndrome

Objective: To provide proper preventive measures and recommend the choicest method of reoperation for different etiology by analyzing etiologies of failed back surgery syndrome.Methods: We retrospectively reviewed 240 patients who diagnosed with failed back surgery syndrome from January 2003 to December 2013.The patients were divided into three groups according to their primary diagnosis before the first operation: The patients from Group one were diagnosed with lumbar disc herniation;The patients from Group two were diagnosed with lumbar spinal stenosis;the patients from Group three were diagnosed with lumbar spondylolisthesis.We also reviewed all patients' medical records,including age,gender,the method of the first operation,the location of the first surgical segment,course of the recurrent disease,new diagnosis,the method of reoperation,the location of the revised surgical segment.We analyzed the etiologies of the failed back surgery syndrome and its method of operation and listed the highest incidence rate of etiology and the method of the first operation.Results: 1.There are 240 patients enrolled in this study including 136 males,104 females;the mean age received surgery was 53.1±11.73 years(range 17-81).2.Group one: 1)There are 182 patients diagnosed with lumbar disc herniation.Among them,there were 107 males and 75 females.The mean age received surgery was 52.3±11.39 years(range 22-79).The age between 45 and 50 has highest incident of revised operation;2)The method of primary surgeries were fenestration laminectomy and discectomy(50.5%),hemilaminectomy or total laminectomy(22.9%),internal fixation(9.6%),internal fixation and posterolateral or interbody fusion(8.5%),minimally invasive surgery such as radiofrequency ablation(4.8%),interbody fusion(1.6%),endoscopic discectomy(1.05%),interspinous fixation(1.05%);3)The etiologies were recurrent lumbar disc herniation(46.7%),lumbar spinal stenosis(21.4%),adjacent segmental diseases(11%),complications(7.%),lumbar spondylolisthesis(5%),lumbar instability(3.3%),the failure of instrumentation(2.2%),epidural fibrosis(1.6%),unknown(1.1%),lumbar scoliosis(0.6%);4)Median time of recurrent symptoms is 48 months and quartile is 108 months;5)The method of the revised operation were internal fixation and posteriolateral or interbody fusion(78%),internal fixation(6.6%),debridement(6%),lumbar exploration and decompression(3.3%), hemilaminectomy or total laminectomy(2.2%),internal fixation removal(2.2%),fenestration laminectomy and discectomy(1.1%),repair of cerebrospinal fluid fistula(0.6%).3.Group two: 1)there are 31 patients diagnosed with lumbar spinal stenosis.Among them,there were 18 males and 13 females.The mean age at surgery was 60.2± 9.68 years(range 39-81).The age between 60 and 65 has the highest incident of revised operation;2)The method of primary surgeries were hemilaminectomy or total laminectomy(45.2%),internal fixation and posteriolateral or interbody fusion(25.8%),internal fixation(19.4%),fenestration laminectomy and discectomy(6.4%),interspinous fixation(3.2%);3)The etiologies were lumbar spinal stenosis(51.6%),the failure of instrumentation(12.9%),complications(12.9%),lumbar instability(9.7%),epidural fibrosis(6.5%),lumbar spondylolisthesis(3.2%),recurrent lumbar disc herniation(3.2%);4)Median of the time of recurrent symptoms is 18 months and quartile is 84 months;5)The method of the revised operation were internal fixation and posteriolateral or interbody fusion(54.8%),internal fixation(9.7%),debridement(9.7%),internal fixation removal(6.5%),lumbar exploration and decompression(3.2%).4.Group three: 1)There are 27 patients diagnosed with lumbar spondylolisthesis.Among them,there were 11 males and 16 females.The mean age received surgery was 51.3±12.64 years(range 17-69).The age between 50 and 55 has the highest incident of revised operation;2)The method of primary surgeries were internal fixation and posteriolateral or interbody fusion(55.6%),internal fixation(33.3%),interbody fusion(7.4%),hemilaminectomy or total laminectomy(3.7%);3)The etiologies were the failure of instrumentation(40.7%),complications(18.6%),lumbar spondylolisthesis(14.8%),lumbar spinal stenosis(7.4%),adjacent segmental diseases(3.7%),recurrent lumbar disc herniation(3.7%);4)Median of the time of recurrent symptoms is 18 months and quartile is 57 months;5)The method of the revised operation were internal fixation and posteriolateral or interbody fusion(51.9%),internal fixation removal(18.5%),debridement(14.8%),internal fixation(11.1%),lumbar exploration and decompression(3.7%).Conclusion:1.The reason of FBSS is not one single factor,recurrent lumbar disc herniation accounting for 36.25%;lumbar spinal stenosis accounting for 23.75%;complications accounting for 9.17%;adjacent level disease accounting for 8.75%;the failure of instrumentation accounting for 7.92%;lumbar spondylolisthesis accounting for 5.83%; lumbar instability accounting for 3.75%;epidural fibrosis accounting for 3.33%;unknown accounting for 0.83%;lumbar scoliosis accounting for 1.42%.2.The highest frequency of the method of primary operation of LDH is fenestration laminectomy and discectomy.3.The highest frequency of the method of primary operation of LSS is hemilaminectomy or total laminectomy.4.The highest frequency of the method of reoperation of primary operation of LS is internal fixation and posteriolateral fusion.