The Effect of Second Operation in Treatment of Failed Back Surgery Syndrome According to the Causes

Abstract

ABSTRACT

Background: Failed back syndrome or failed back surgery syndrome (FBSS) refers to a condition in which a patient has undergone back surgery with a poor outcome. Patients with FBSS are a diverse group, with complex and varied etiologies and pain sources. They also vary with regard to their clinical complaints and psychological status. Patients with FBSS typically experience a decrement in their functional capacity, morale, and productivity. They are also more vulnerable to developing psychosocial problems and addiction to pain medication

Objectives: To find the best treatment for FBSS depending on the cause and to evaluate if the second operation is the best treatment?

Methods: Thirty-five cases were evaluated as FBSS and analysed as a retrospective case-series study. These cases were collected from Feb. 2009 to June 2012 in Neurosciences hospital and two private hospitals (Red Crescent and Al-Amal). FBSS were accepted as the cases which were in worse condition than their former preoperation status or were not better postoperatively. All cases were submitted to another surgery as a treatment of FBSS.

Results: Thirty five cases; 18 were females (51.4%) and 17 were males (48.6%). Ages ranged from 22 to 72 and the average of ages was 49±13.5. The onset of symptoms of FBSS cases ranged from 15 days to 12 months. Of these thirty five cases; 24 cases (68.5%) were due to recurrent disc herniation, 5 cases (14.2%) were due to epidural fibrosis, 2 cases (5.7%) were due to lumbar stenosis, 2 cases (5.7%) were due to foraminal stenosis, 1 case (2.8%) was due to discitis and paraspinal abscess and 1 case (2.8%) was due to CSF fistula. Success rate according to the Japanese Orthopaedic Association (JOA) scoring; was found as 40.6% for the cases with epidural fibrosis and 76.9% for the cases with recurrent disc herniation (DH). Statistical comparison was found as meaningful (p<0.05).

Conclusion: Recurrent disc herniation; which occur on the same level, the same side or opposite side, is the most frequently observed cause for reoperation (68.5%). Epidural fibrosis formation is second frequent cause (14.2%) for reoperation. While the success rate of all failed back surgery syndrome cases is found as; 40.6% for the patients with epidural fibrosis and 76.9% for the patients with lumbar disc herniation (DH). The statistical comparison is found as meaningful of these cause to re-operate successfully (p<0.05), while the other causes of failed back surgery are statistically non vulnerable to re-operate.