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Outcome following lumbar disc surgery: the role of fibrosis

  • Clinical Article
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Abstract

Background

Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis.

Method

Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, The Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI).

Findings

After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). The values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability.

Conclusions

The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.

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Acknowledgement

Special thanks to Mrs. Marli Uchida and Mrs. Susan Kondagelski for the English edition and to Dr. Erasmo Barros for the drawings.

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Authors and Affiliations

  1. Instituto de Neurologia de Curitiba, Abílio César Borges, 79/61, Curitiba, 80730-060, Brazil

    Daniel Benzecry Almeida, Jeronimo Buzetti Milano, Kelly Cristina Bordignon & Ricardo Ramina

  2. Universidade Federal de São Paulo, São Paulo, Brazil

    Daniel Benzecry Almeida & Mirto Nelson Prandini

  3. CEDIP, Curitiba, Brazil

    Yumi Awamura, Maria Luiza Vitola & Monica Pedro Simião

  4. CINDOR, Instituto de Neurologia de Curitiba, Curitiba, Brazil

    Mariane Pastuch Ache

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  1. Daniel Benzecry Almeida
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  2. Mirto Nelson Prandini
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  3. Yumi Awamura
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  4. Maria Luiza Vitola
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  6. Jeronimo Buzetti Milano
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  7. Kelly Cristina Bordignon
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  9. Ricardo Ramina
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Correspondence to Daniel Benzecry Almeida.

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Almeida, D.B., Prandini, M.N., Awamura, Y. et al. Outcome following lumbar disc surgery: the role of fibrosis. Acta Neurochir (Wien) 150, 1167–1176 (2008). https://doi.org/10.1007/s00701-008-0131-2

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  • DOI: https://doi.org/10.1007/s00701-008-0131-2

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