Failed back surgery syndrome: casuistic and etiology / Síndrome pós-laminectomia: casuística e etiologia

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 percent) had presented criteria for the FBSS. Among the 26 patients who had presented operative diagnosis of lumbar stenosis, 8 (30.7 percent) had presented FBSS; of the 83 with disc herniation, 31 (37.3 percent) had the syndrome; and the 12 patients with lumbar stenosis associated with disc herniation, 7 (58.3 percent) 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.

RESUMO

OBJETIVO: Relatar nossos dados sobre a síndrome pós-laminectomia (SPL) e as causas cirúrgicas e não-cirúrgicas. MÉTODO: Foram revisados 121 prontuários de pacientes submetidos a laminectomia, hemilaminectomia combinadas com discectomia e/ou foraminotomia realizadas no Instituto de Neurologia Deolindo Couto entre janeiro de 1997 e outubro de 2004. RESULTADOS: Dos 121 pacientes que sofreram intervenção cirúrgica lombar, 47 (38,8 por cento) apresentaram critérios para a SPL. Dos 26 pacientes que apresentaram diagnóstico pré-operatório de estenose lombar, 8 (30,7 por cento) apresentaram SPL; dos 83 com hérnia de disco, 31 (37,3 por cento) tiveram a síndrome; e dos 12 pacientes com estenose lombar associada com hérnia de disco, 7 (58,3 por cento) tiveram a SPL. CONCLUSÃO: A síndrome pós-laminectomia permanece um desafio para os cirurgiões. Há uma busca incessante pelas causas e os mecanismos de ação desta síndrome e o melhor método de tratamento.