Summary
Failures and poor results of 160 patients after lumbar spinal surgery between 1980 and 1984 were analysed retrospectively. A self-rated questionnaire carried out 12 months after operation revealed 20 poor results; these occurred most commonly after multiple operations, decompression and fusion as compared to disc excision. The commonest cause was failure to recognise abnormal pain behaviour before operation. A more careful preoperative assessment should reduce the incidence of failure.
Résumé
L'étude rétrospective de 160 opérés du rachis lombaire, de 1980 à 1984, à l'hôpital général de district, a permis d'analyser les échecs et les mauvais résultats. Grâce à un questionnaire adressé à ces malades un an aprés l'intervention on a pu retrouver 20 mauvais résultats. Ces vingt cas ont été réexaminés afin de déterminer la cause de ces échecs. Il y avait davantage de mauvais résultats aprés chirurgie itérative, aprés décompression et arthrodèse qu'aprés simple discectomie. La cause habituelle de ces échecs était une mésestimation, lors de l'examen pré-opératoire, d'une réaction anormale à la douleur. Il semble qu'un examen plus attentif des patients lombalgiques puisse diminuer le nombre des échecs du traitement chirurgical.
Similar content being viewed by others
References
Bartorelli D (1983) Low back pain — a team approach. J Neurosurg 15: 41–44
Britt RH, Ryan T (1986) Use of a flexible epidural stimulating electrode for intra-operative monitoring of spinal somato-sensory evoked potential. Spine 11: 348–351
Connolly JF (1983) Does operative treatment of lumbar disc syndrome produce more disability than it prevents? Nebraska Med J 1: 155–156
Finnegan BE, Rothman RH, Fenlin JMJ, Marvel JP, Nardini R (1975) Litigation has an adverse effect in outcome of surgery. J Bone Jt Surg [Am] 57: 1034
Grabias S (1980) The treatment of spinal stenosis. J Bone Jt Surg [Am] 62: 308–313
Herron LD, Turner J (1985) Patient selection for lumbar laminectomy with a revised objective rating system. Clin Orthop 199: 145–152
Herron LD, Turner J, Clancy S, Weiner P (1986) The differential utility of the Minnesota multiphasic personality inventory. Spine 11: 847–853
Howe J, Frymoyer JW (1986) Effects of questionnaire design on the determination of end results in lumbar spinal surgery. Spine 10: 804–805
Klenerman L, Greenwood R, Davenport HT, White DC, Peskett S (1984) Lumbar epidural injections in the treatment of sciatica. Br J Rheumatol 23: 35–38
Langenskjold A, Kiviluoto O (1976) Prevention of epidural scar formation after operations on the lumbar spine by means of free fat transplants. Clin Orthop 115: 92–95
Leyshon A, Kirwan EO'G, Wynne Parry CB (1981) Electrical studies in the diagnosis of compression of the lumbar root. J Bone Jt Surg [Br] 63: 71–75
Lin PM (1982) Internal decompression for multiple levels of lumbar spinal stenosis. Neurosurg 11: 546–549
Lloyd GG, Wolkind SN, Harris DJ (1979) A psychiatric study of patients with persistent low back pain. Rheumatol Rehab 18: 30–34
McCulloch JA (1977) Chemonucleolysis. J Bone Jt Surg [Br] 59: 45–52
Merriam WF, Smith NJ, Mulholland RC (1982) Lumbar spine stenosis. Br Med J 289: 515
Nabarro J (1984) Unrecognised psychiatric illness in medical patients. Br Med J 289: 635–636
Naylor A (1974) The late results of laminectomy for lumbar disc prolapse. J Bone Jt Surg [Br] 56: 17–29
Nelson MA, Allen P, Clamp SE, De Dombal FT (1979) Reliability and reproducibility of clinical findings in low back pain. Spine 4: 97–101
O'Brien JP (1983) The role of fusion for chronic low back pain. Orth Clin N Am 14: 639–647
Petty NE, Mastria MA (1983) Management of compliance to progressive relaxation and orthopaedic exercises in the treatment of chronic pain. Psychol Reports 52: 35–38
Roberts AH, Reinhardt L (1980) The behavioural management of chronic pain. Pain 8: 151–162
Schatzker J, Pennal GF (1968) Spinal stenosis. J Bone Jt Surg [Br] 50: 606–618
Selecki BR, Ness TD (1982) Multiple operations for lumbar disc herniation. Austral New Zeal J Surg 52: 230
Teplick JG, Haskin ME (1983) CT of the postoperative spine. Radiol Clin N Am 21: 395–420
Tsushima WT, Towne WS (1979) Clinical limitation of low back scale. J Clin Psychol 35: 306–308
Waddell G, Kummel EG, Lotto WN, Graham JD, Hall H, McCulloch JA (1980) Failed lumbar disc surgery following industrial injuries. J Bone Jt Surg [Am] 61: 201–207
Waddell G, McCulloch JA, Kummel E, Vender RN (1980) Non-organic Physical signs in low back pain. Spine 5: 117–125
Waddell G, Morris EW, Paola MPD, Bircher M, Finlayson M (1986) A concept of illness tested as an improved basis for surgical decisions in low back disorders. Spine 7: 712–719
Weber H (1983) Lumbar disc herniation. Spine 8: 131–140
Wifling FJ, Klonoff H, Kokan P (1973) Psychological, demographic and orthopaedic factors associated with prediction of outcome of spinal fusion. Clin Orthop 990: 153–160
Wiltse LL, Kirkaldy-Willis WH, McIvor GWD (1976) The treatment of spinal stenosis. Clin Orthop 115: 83–91
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dhar, S., Porter, R.W. Failed lumbar spinal surgery. International Orthopaedics 16, 152–156 (1992). https://doi.org/10.1007/BF00180207
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF00180207