A Retrospective and prospective analysis of functional outcome of revision lumbar surgery for failed back surgery syndrome

Neelakannan, R (2015) A Retrospective and prospective analysis of functional outcome of revision lumbar surgery for failed back surgery syndrome. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: About 40% of patients who got operated for the low back pain came with persistent or recurrent pain following the surgery. The causes of pain are recurrent disc prolapse, post laminectomy instability, instrumentation failure, pseudoarthroses, Adjacent level degeneration, flat back syndrome. In this study we evaluate the functional outcome of these patients after the revision surgery. AIM AND OBJECTIVE: To retrospectively and prospectively study the functional outcome of revision lumbar surgery for failed back surgery syndrome. MATERIALS AND METHODS: This study was conducted among 20 patients who came with recurrent pain after the index surgery at Rajiv Gandhi Govt. General hospital, Chennai -03. Our study had a female predominance with a mean age of 41.1 yrs. The patients were evaluated clinically for pain and disability by the VAS and ODI score respectively. Objective evaluation also done by the neurological examination. Routine radiographs, CT scans and MRI are taken to diagnose the cause of recurrent pain. The evaluated patients were operated, targeting the cause of pain. Spinal fusion was done in 50% of patients. Post operatively patients were evaluated with ODI,VAS score. OBSERVATIONS AND RESULTS: The major cause of the recurrent in this study is recurrent disc( 40%), post laminectomy instability(35%), instrumentation failure(25%). The mean pain free interval is 30.95 months. The mean number of previous surgery is 1.13. The overall success rate in our study was 60%. The patients with pain free interval more than 6 months had better outcome than the patients with PFI less than 6months. Patients operated for instability had better outcome than other patients. DISCUSSION: The success following the revision surgery depends on the proper preoperative evaluation, precise diagnosis, pain free interval, number of previous surgeries, age, sex and the experience of the operating surgeon. The overall success rate was 60%. The patients with the instability had good outcome than the other group patients which is comparable to other studies. Patients with PFI > 6 months have good outcome than with patients < than 6 months which is statistically significant. Younger patients had better outcome which may be due to good post op rehabilitation. Outcome of the patients treated with fusion and without fusion had similar results this is because the short term follow up. CONCLUSION: Proper preoperative evaluation, diagnosing the specific pathology and targetting the pathology is of paramount importance in the management of failed back surgery syndrome. Good experience and expertise in meticulous dissection prevents complications like dural tears and infections. Spinal fusion is mandatory in cases of postlaminectomy instability, and recurrent disc prolapse with demonstrable instability. For the successful outcome of the revision surgery for failed back syndrome spinal fusion is compelling. However a long term follow up and a larger sample study is needed to further validate our findings.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Failed back surgery syndrome ; Spinal fusion ; ODI score ; VAS score ; pain free interval.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 01:00
Last Modified: 25 Sep 2017 01:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/3298

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