Abstract
The reported results for primary lumbar disc surgery in open standard technique are succesful in 80–95% of patients, while after repeated surgery range from 28 to 81%.
The best clinical results occur when there is an indication of neurological impairment, nerve root compression and radiological confirmation. We report the results of a retrospective study on 54 patients, aged 30 – 65 years, who were presented with recurrence of symptoms and operated on for a 2nd or 3rd time after a previous discectomy, between the period 1990 to 2001.
Objective: The aim of the study is to determine the factors that influence the results after repeated surgery and to analyse those that lead to failure.
Material and Methods: The 54 patients were submitted in a detailed clinical and radiological examination (CT-scan, MRI, EMG) in an attempt to determine the exact indication for re-operation.
The preoperative findings for the revision surgery were: Radiculopathy secondary to a new herniation, 14 patients.
Due to recurrent disc prolapse at the same level, 9 patients.
Due to lateral recess stenosis, 12 patients.
Instability secondary to a previous wide laminectomy, 4 patients.
No obvious cause, probably due to fibrosis, 5 patients. Multiple root syndrome due to a tumor, 1 patient. Cauda equina syndrome due to an hematoma 1 patient.
The follow-up of the patients ranges between 1–12 years and the results of the revision surgery are classified according to Finnegan’s classification.
Results: From the 54 patients, 30 had a good result (56.6%), 16 fair (29.4%) and 8 poor (15%)
Forty-six patients rated the revision surgery worthwhile (85%).
Conclusions: The factors with good prediction of the results were:
Relief of pain more than 6 months after the previous surgery.
Sciatica > Low back pain.
Nerve root compression from a new herniation in another level or recurrence at the same.
Lateral recess stenosis.
Good correlation of the clinical and radiological findings.
The factors with bad prediction were
The intra-operative fibrosis.
Pain relief less than 6 months
The bad psychological condition of the patients.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
