IPSILATERAL RADICULAR PAIN

FOLLOWING DISCECTOMY

K. Liaropoulos, P. Spyropoulou, P. Korovesis,

Th. Maraziotis, N. Papadakis

FAILED BACK SURGERY SYNDROME(FBSS)

Refers to surgeries in the lumbarregion of the spine for varyingreasons (such as a herniated disc orspinal stenosis) and of varioussurgical techniques, without satisfactoryimprovement of symptoms.The etiology is multifactorialIts frequency reaches 10-40%

The development of a herniated disc at the same or another level of the same side and the consequent radicular syndrome, is in our opinion, a new nosological entity and the previous intervention should not be considered "failed", even if it relates indirectly, probably for reasons of biomechanical dynamics to the foregoing procedure.

The term "failed back surgery syndrome" is the

subject of this study, refers to cases of FBSS where

re-operation was necessary due to persistence (or

deterioration) or recurrence of the same radicular

syndrome with the syndrome of the preoperative

period of the first intervention which was performed

by the same technique (open hemilaminectomy

discectomy).

It is part of the general FBSS with more specific and

strict selection criteria.

OBJECTThis study aims to:

1) investigate the etiology of the persistence or

recurrence of the same radicular syndrome (the

same root in the same side) in cases where re-

operation was necessary.

2) investigate the relationship of gender, age and profession with persistence or recurrence of radicular pain.

3) investigate the correlation of time of occurrence of radicular pain

MATERIAL AND METHOD

PERIOD: February. 1995 - January 2000

MATERIAL: 64 patients showed either persistenceor recurrenceof pre-operative symptomsDuring the same period 1016 patients hadundergone surgery for a lumbar herniated disc

They were studied in terms of:medical historyobjective neurological examinationimaging methodssurgical findingspostoperative findings

LOW BACK PAIN

•Common symptom (second in frequency after headache)•5% annual rate.•Cause of activity limitation to adults under45 years of age.•Cause of loss of earnings and workers' compensationin the USA•14 billion US dollars annual cost for diagnosis andtreatment.•1% accompanied by ischialgia, whichin majority is due to a herniated intervertebral disc

ISCHIALGIA - LUMBAR HERNIATED DISC

85% of patients have a favorable result followingconservative treatment, in average 6weeks (rest, analgesics, physiotherapy)

15% of patients require surgical interventionIn 8% -25% of cases, surgical treatmentfails to relieve patients frompain or recurrence of symptoms afterdifferent than other times interval.

Table 1: Epidemiological characteristics of studiedcases

CHARACTERISTICS NUMBER OF CASES PERCENTAGE %

GENDERMenWomen

4321

6733

AGE < 20 20-50 > 50

03925

06139

PROFESSIONFarmers-WorkersOther 17

472773

TOTAL 64 100

Table 2: Age-focused analysis of cases

AGE NUMBEROF CASES

PERCENTAGE %

<20 0 0

21- 30 3 5

31- 40 14 22

41- 50 22 34

51- 60 15 23

61- 70 6 9

>70 4 6

TOTAL 64 100

Table 3: Comparison of surgical findings and CTin 32 cases

Recurrence of herniated disc 19 /14

Epidural fibrosis 3 / 8

Stenosis of lateral diverticulum +concretions

6 / 16

New projection at another level 4 / 4

Table 4: Comparison of surgical findings and MRIin 46 cases

Recurrence of herniated disc 17 /14

Epidural fibrosis 7 / 8

Stenosis of lateral diverticulum +

concretions

18 / 16

New projection at another level 4 / 4

Table 5: Postoperative monitoring andepidemiological characteristics

SUCCESSFUL UNSUCCESSFUL

NUMBER OFCASES

% NUMBER OFCASES

% TOTAL

GENDERWOMENMEN

1834

85%79%

39

15%21%

2143

AGE 20-50 >50

3220

82%80%

75

18%20%

3925

PROFESSIONFARMERS/WORKERSOTHER

1636

89%78%

210

11%22%

1846

TOTAL 52 81% 12 19% 64

Table 6: The clinical profile of 64 patients

BEFORE THE RE-OPERATION

AFTER THE RE-OPERATION

NUMBER OF CASES

% NUMBER OF CASES

%

Motor deficit No Paresis

4321

67%33%

5212

81%17%

Sensory deficit No Hypoaesthesia

460

6%94%

1153

15%83%

Reflexes decreased orabsent Normal

3826

59%41%

2935

46%64%

Table 7: Surgical findings and results

SUCCESSFUL UNSUCCESSFUL

ETIOLOGY NUMBER OFCASES

% NUMBER OFCASES

%

• Operatedincorrect level

4 6 % 0 0%

• Remaining disc 10 16% 0 0%

• Recurrence of herniated disc

14 22% 0 0%

• Stenosis of lateral diverticulum

5 8% 1/5 3%

• Concretions 6 9% 2/7 3%

• Stenosis of lateral diverticulum+concretions

9 14% 7/14 11%

• Pseudomeningomyelocele

3 5% 0 0%

• Permanent root trauma 0 0% 1/1 2%

• Epidural hematoma 1 1% 0 0%

TOTAL 52 81% 12/64 19%

Table 8: Time of recurrence of symptoms and results

TIME RESULTSSUCCESSFUL UNSUCCESSFUL TOTAL

EXCELLENT VERY MODERATE

RELATIVE FAILURE

ABSOLUTE FAILURE

1ST WEEK 13 3 3 0 1 20

2-4TH WEEK 0 9 5 1 0 15

1-6 MONTHS 0 2 7 3 5 17

6 MONTHS - 3 YEARS

0 6 4 2 0 12

TOTAL 13 20 19 6 6 64