Clinical Analysis of Prognostic Factors Following Reoperation for Lumbar Disc Herniation

ABSTRACT

The surgical outcome of lumbar discectomy has improved with advance of surgical technique and diagnostic equipment. But failed back surgery syndrome was still remains to be elusive. The purpose of this study was to evaluate the possible causes for failure of primary discectomy and prognostic factors which could influence the outcome of reoperation in failed back surgery syndrome. The authors were able to follow up and analyze 525 cases who underwent surgery due to herniated lumbar disc from May 1994 to 1997 in our institution. Among these, fifty two patients were reoperated due to recurrent disabling pain and neurological deficits. The most common intraoperative findings of patients with reoperation were foraminal stenosis(36.5 % ) followed by epidural fibrosis with remained disc materials(34. 5% ). These patients had variable outcomes, especially those having infection, fibrotic adhesion, legal problems, and psychiatric problems showed unfavorable outcomes. In overall, 49.8% of patients showed satisfactory results(good and excellent). Favorable outcome could be obtained with a history of good results from previous operations, with the absence of epidural fibrotic adhesion with predominance of radicular pain, with lesser frequency of operative procedure, with more than 6 months of symptom duration after primary operation. Morever, most common initial operative method was hemipartial laminectomy, but 17.3% of patient with reoperation had histories of percutaneous endoscopic decompressive surgery. Intraoperative findings of these patients showed spinal stenosis or remained disc materials. Although theses number of patients was small for total number of patients. These operative findings suggest that the choice of initial operative method seemed to be important factor influencing the postoperative results. As mentioned above, there are many factors influencing the outcome in lumbar disc herniation operation. Prevention of epidural fibrosis and proper selection of surgical technique in primary operation should be considered as important factor obtaining the better outcome.