The Failed Back Surgery Syndrome

Fritsch, Ekkehard; Heisel, Jürgen; Rupp, Stefan

doi:10.1097/00007632-199603010-00017

Cited by 380 publications

(92 citation statements)

References 21 publications

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“…The percentage of patients undergoing a revision lumbar surgery ranges from 5 to 33% [2,8,9,12,16,[19][20][21]26] and varies widely across geographic regions [2,3] and kind of surgery [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of epidural fibrosis makes more difficult to highlight and separate cleavage planes during revision lumbar surgery [1]. It is evident after the first intervention with a rate of 44%, and is not a problem only for revision surgery, but also for patients who need second intervention [8].…”

Section: Discussionmentioning

confidence: 99%

“…The intraoperative complications during revision surgery are bleeding from the epidural veins, dural and nerve root tears [8].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Denaro¹,

Martino²,

Longo³

et al. 2008

Eur Spine J

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Denaro¹,

Martino²,

Longo³

et al. 2008

Eur Spine J

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“…It occurs in 13-61% of patients who undergo back surgery [4,34]. The reasons for FBSS include inadequate surgical decompression, recurrent disc herniation, lumbar instability, extensive epidural scar, and inadequate fusion [7]. The postoperative epidural scar can cause extradural compression or dural tethering, which results in recurrent radicular pain and physical impairment [27].…”

Section: Introductionmentioning

confidence: 99%

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Huang

Fan

2009

Eur Spine J

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Postlaminectomy epidural adhesion is implicated as a main cause of ''failed back surgery syndrome'' and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications.

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“…One needs to consider that revision surgery in these patients has a high failure rate as far as patient satisfaction is concerned. [22][23][24][25] Salvage surgery usually includes combined anterior and posterior spinal surgery [23][24][25] or posterior extension osteotomies with extension of the fusion. 23 In our opinion, an isolated single-level disc replacement after previous fusion surgery can only correct a limited degree of lumbar Á at-back deformity.…”

Section: Discussionmentioning

confidence: 99%

Kineflex (Centurion) Lumbar Disc Prosthesis: Insertion Technique and 2-Year Clinical Results in 100 Patients

Hähnle¹,

Weinberg²,

Sliwa³

et al. 2007

SAS Journal

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Adjacent-level degeneration is a major concern in lumbar fusion operations. [1][2][3][4] Lumbar artiÀ cial discs are an alternative to arthrodesis (fusion). The purpose of total disc replacement is to restore the intervertebral segment and protect the adjacent levels against abnormal loading conditions. A description of the surgical insertions of a lumbar prosthetic nucleus replacement, ABSTRACT BackgroundThe KineÁ ex lumbar disc is a mechanical, unconstrained, re-centering disc prosthesis developed in South Africa. The À rst implantation took place in October 2002. We present a single-center, prospective, longitudinal study of the À rst 100 patients treated with the KineÁ ex lumbar disc. Our objective was to evaluate the insertion technique, clinical outcomes, and patient satisfaction at 2 years postimplantation in 100 consecutive patients with 132 (68 single-and 32 2-level) KineÁ ex lumbar disc replacements. MethodsWe determined the exact central placement of all disc implants in the coronal and midsagittal planes. We measured clinical outcome with the Oswestry disability index (ODI), our own questionnaire, and the time needed to return to work. All patients received radiological and clinical follow-up assessments for 2 years after the index procedure. ResultsForty-three patients were female. The mean age of the patients at operation was 44.9 years (range, 23-63 years). Postoperative hospitalization averaged 2.8 days (range, 2 to 8 days). All patients who were employed before surgery returned to work 31 ± 16.8 days after the operation. Fifty-six percent of operated disc levels had intervertebral disc heights of less than 5 mm. A 2-year clinical outcome was available for 98 of the 100 patients (58 excellent, 30 good, 7 fair, 3 poor). The ODI score improved from 47.8 ± 16.0 preoperatively to 14.2 ± 14.0 (P < .01) at 2 years. At 2 years, 95% of disc implants were radiologically in the ideal position. The insertion technique, with a released prosthetic mechanism for À nal placement, allowed ideal placement in the sagittal plane in 98% of discs. The radiographic placement accuracy achieved was equal in patients with preoperative intervertebral disc height below and above 5 mm. ConclusionsGood short-term clinical results were achieved with the KineÁ ex disc in a heterogeneous patient group with a high number of patients with advanced disc degeneration, severe disc space narrowing, and lumbar Á at-back deformity. In this cohort, accurate implant placement could be achieved in our À rst 100 patients. Clinical RelevenceThis is the À rst report on the KineÁ ex mechanical lumbar disc prosthesis.Key Words KineÁ ex disc, degenerative disc disease, lumbar disc prosthesis, insertion technique, unconstrained disc prosthesis, Oswestry disability index.

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The Failed Back Surgery Syndrome

Cited by 380 publications

References 21 publications

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Kineflex (Centurion) Lumbar Disc Prosthesis: Insertion Technique and 2-Year Clinical Results in 100 Patients

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