The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments

A retrospective study was performed of 182 revisions on failed back surgery syndrome from the years 1965 to 1990. To analyze the reasons for failure of primary discectomy, the outcome of the revisions, and factors that influenced those outcomes. The reported reintervention rates after lumbar discectomy range from 5% to 33% depending on the type of surgical procedure. The authors' former investigations reported a revision rate of 10.8% in evaluating 1500 lumbar discectomies. Because the documentation was standardized, detailed data of all patients were available. To gain further information concerning the long-term results a questionnaire was used. Computer processing and statistical tests were performed. One hundred eighty-two revisions were performed on 136 patients. Forty-four patients (34%) were revised multiple times. Generally, recurrent or uninfluenced sciatic pain and neurologic deficiency or lumbar instability led to reintervention. Recurrent lumbar disc herniation mainly was found at the first reintervention. In multiple revision patients the rate of epidural fibrosis and instability increased to greater than 60%. In 80% of the patients the results were satisfactory in short-term evaluation, decreasing to 22% in long-term follow up (2-27 years). Laminectomy performed in primary surgery could be detected as the only factor leading to a higher rate of revisions. A trend toward poor results after recurrent disc surgery seems to be fateful because of the development of epidural fibrosis and instability. In severe discotomy syndrome, a spinal fusion seems to be more successful than multiple fibrinolyses.