Failed back surgery syndrome: casuistic and etiology

Abstract

OBJECTIVE: To report our data of cases of failed back surgery syndrome (FBSS) and surgical and nonsurgical etiologies. METHOD: The medical charts of 121 patients submitted to laminectomy, hemilaminectomy combined with discectomy and/or foraminotomy between January 1997 and October 2004 in the Instituto of Neurologia Deolindo Couto were reviewed. The inclusion criterion was does not improve or the symptoms return after the surgery and with a minimum of three medical consultations with adequate investigation for the diagnosis. The patients had been divided in three main pre-surgical diagnosis: herniated disc, lumbar stenosis and the association of these. RESULTS: From the 121 patients submitted to spine surgical intervention, 47 (38.8%) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7%) had presented FBSS; of the 83 with disc herniation, 31 (37.3%) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3%) had failure of the back surgery. CONCLUSION: The failure of back surgery remains a challenge for the surgeons. There is an incessant search for the causes and the action mechanisms of this syndrome and the best method of treatment.

Manipulation under anesthesia for patients with failed back surgery: retrospective report of 3 cases with 1-year follow-up

“…3 Several etiologies for failed back surgery syndrome have been suggested, including epidural fibrosis, canal stenosis, sacroiliac joint syndrome, facet syndrome, spondylolisthesis, and recurrent disk prolapse. 4 Although there are many studies on MUA, only one reported on outcomes following previous surgical intervention and failed back surgery syndrome. 5 The purpose of this study is to report on the outcomes of 3 patients who had been diagnosed with failed back surgery syndrome and chose to receive a serial MUA procedure.…”

Experimental Model of Intervertebral Disk Mediated Postoperative Epidural Fibrosis

“…The destruction of intervertebral cartilage triggers the cascade mechanism of cellular immunity, which leads to formation of anti-disk antibodies. Antigen-antibody complexes stimulate the production of pro-inflammatory substances (cytokines, prostaglandin E) and proteolytic enzymes (proteases, collagenases) that induces progressive degeneration of the intervertebral disk and adhesions development with other structures of the spinal canal [4,7] . In modern science, researchers preserve high interest to this subject due to the fact that development of EF is one of the reasons of compression and fixation of neurovascular structures and circular stenosis of spinal canal, leading respectively to pain occurrence and neurological symptoms in patients undergoing spinal surgery.…”

“…Epidural fibrosis (EF) has been described in 24-38% of patients with failed back surgery syndrome [1][2][3] . Re-operations, aimed at adhesiolysis and scar resection are difficult and ineffective and have higher risk of complications [4][5][6] . Although surgical intervention is important for the pathogenesis of postsurgical forms of EF, some aspects of this disorder are difficult to explain based only on wound healing process [7,8] .…”

Failed Back Surgery: A Clinical Review

“…[14] Similar results have been reported in other studies of asymptomatic population [15] . According to these results, it can be concluded that trusting only to imaging techniques is a wrong way of deciding surgery [13][14][15][16][17] . The long term controlled studies claimed the necessity of establishing real surgical indications, and they also found no differences between conservative and surgical treatment for the lumbar disc hernias [18,19] .…”