Failed back surgery syndrome: 5-year follow-up in 102 patients undergoing repeated operation.

The indications for repeated operation in patients with persistent or recurrent pain after lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and in no case has mean follow-up exceeded 3 years. We report 5-year mean follow-up for a series of repeated operations performed between 1979 and 1983. Patient characteristics and modes of treatment have been assessed as predictors of long-term outcome. One hundred two patients with "failed back surgery syndrome" (averaging 2.4 previous operations), who underwent a repeated operation for lumbosacral decompression and/or stabilization, were interviewed by a disinterested third party a mean of 5.05 years postoperatively. Successful outcome (at least 50% sustained relief of pain for 2 years or at last follow-up, and patient satisfaction with the result) was recorded in 34% of patients. Twenty-one patients who were disabled preoperatively returned to work postoperatively; 15 who were working preoperatively became disabled or retired postoperatively. Improvements in activities of daily living were recorded, overall, as often as decrements. Loss of neurological function (strength, sensation, bowel and bladder control) was reported by patients more often than improvement. Most patients reduced or eliminated analgesic intake. Statistical analysis (including univariate and multivariate logistic regression) of patient characteristics as prognostic factors showed significant advantages for young patients and for female patients. Favorable outcome also was associated with a history of good results from previous operations, with the absence of epidural scar requiring surgical lysis, with employment before surgery, and with predominance of radicular (as opposed to axial) pain.(ABSTRACT TRUNCATED AT 250 WORDS)

The critical role of 3-D CT reconstructions for defining spinal disease.

Three dimensional processing of routine CT images has previously been applied to osseous related maxillo-facial and spinal disorders. Two groups of patients, 25 with substantial spinal trauma and 25 with 'failed back' syndrome had 2-D and 3-D like displays processed by the Cemax 1000 system. The goal was to objectify whether the adjunct of 3-D imaging was truly valuable diagnostically. All images were recorded on 35 mm slides and projected both randomly and as an organized case; intra- and interpersonal evaluations were made. 3-D imaging in 19 of the 25 (76%) trauma patients disclosed additional diagnostic information which was considerably important to both the neuroradiologist and the referring surgeon. In the 'failed back' group, the 3-D images showed supplementary information in 15 of 25 (60%) cases. 3-D displays were usually in color showing complete regional information obtained from high resolution, medium thickness (4 mm) CT slices with minor overlapping (1 mm). The displays were optimized to the plane best defining the pertinent osseous and joint morphology; this included variably rotated and sometimes hemisected views. The images presented here are static, however, when viewed rapidly or by dynamic rotation, the regional morphology results in a highly graphic 3-D presentation.

Use of microfibrillar collagen as a topical hemostatic agent in brain tissue.

Microfibrillar collagen, a recently introduced topical hemostatic agent, was used to obtain hemostasis in suction-evacuation lesions of canine cortex. Gelatin foam was used as a control in identical lesions on the opposite side. Microfibrillar collagen was found to be faster acting and more effective than gelatin foam. Histological evaluation of the lesions at 2,4, and 6 months postoperatively showed no significant difference in the amount or type of tissue reaction to the two agents.

Cerebral tuberculoma localized by EMI scan.

A case of isolated supratentorial tuberculoma is described. The patient had a left facial palsy, left hemiplegia, and left proprioceptive and stereognostic deficits with negative studies until the lesion was delineated with computerized axial tomography (EMI scan). The characteristics EMI scan is helpful in delineating the nature and precise location of the lesion prior to surgery.