Findings and outcome of revision lumbar disc surgery.
One hundred fourteen patients (64 men, 50 women) with prior lumbar disc surgery underwent a reexploration for intractable back and/or leg pain. The finding in revision surgery included disc herniation in 89 cases (78%), epidural fibrosis in 14 cases (12.2%), adhesive arachnoiditis in 4 cases (3.5%), isolated lateral spinal stenosis in 3 cases (2.6%), and iatrogenic instability in 4 cases (3.5%). Review of operative reports of patients who underwent a first operation in our institute revealed that seven cases (12.5%) had a second laminotomy without a discectomy in addition to the previous laminotomy and discectomy performed in the same session. Fifty-six of the patients with disc hemiation in revision surgery had a true recurrence. Disc hemiation was protruded in 38 cases (42.8%), extruded in 44 cases (49.4%), and sequestrated in 7 cases (7.8%). The outcome was assessed using Prolo's functional and economic scale. According to Prolo's scale, a good outcome was detected in 79 cases (69.2%), moderate in 22 (19.2%), and a poor outcome was detected in 13 cases (11.4%). The best outcome was achieved in patients with disc hemiation. It is concluded that recurrent disc disease is the most important cause of reexploration. This fact dictates a careful preoperative workup and discectomy in the first intervention. The likelihood of occurrence of disc herniation in the negative laminotomy level (i.e., laminotomy without discectomy procedure) also requires a careful preoperative radiologic workup before lumbar disc surgery.
Ozgen
S
S
Department of Neurosurgery, Marmara University, School of Medicine, Istanbul, Turkey.
Naderi
S
S
Ozek
M M
MM
Pamir
M N
MN
D000328:Adult; D000368:Aged; D001100:Arachnoiditis / Q000209:etiology / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects; D004824:Epidural Space / Q000473:pathology; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013130:Spinal Stenosis / Q000209:etiology / Q000601:surgery; D000267:Tissue Adhesions / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome