wang xi yang--failed back sugery syndrome (2)

Imaging (-) ) 3 Secondary to lateral Secondary to lateral recess stenosis stenosis Missed 2 4
Imaging data
Positioning error Positioning error 3 Lumbar instability 6 11 Disc and then Disc and then highlight 12 Oppression Oppression organizations continue organizations continue to persist
The analysis and prevention of failed back sugery syndrome
Wang xi yang
Department of Spinal Surgery, Xiangya Hospital， Central South University
Concept
Rrefore, by lumbar surgery syndrome patients treated, to analyze the reasons for the FBSS , provide prevention strategies and improve the satisfaction rate of lumbar spine surgery .
Background
Lumbar disease is most common in spine disease
in recent years, mature and high penetration of lumbar spine surgery Follow-up of lumbar spine surgery that caused a lack of system reports FBSS patients in the lumbar spine surgery in the incidence rate of 5% to 40% with an average of 15%
General Information
Time: January 2007-January 2010 Duration: duration of 1 month to 5 years, the average duration of 3 years Case: Semi-laminectomy in 12 cases, laminectomy in 9 cases, interbody fusion pedicle screw fixation in 22 cases,23 males and 20 females, aged 11-70 years, mean 39 years old Symptoms: no significant improvement in limb symptoms in 6 cases, lower extremity residual persistent low back pain in 21 cases,Lower back muscle weakness in 4 cases, hallux back extensor muscle weakness in 3 cases, fever associated with low back pain in 3 cases, 6 cases of contralateral low back pain
JOA score
Table of JOA score before and after treatment
JOA score before treatment
Number of cases
JOA score after treatment
<10
10-15 2 2
16-24 3 8 3
25-29
<10 10-15 16-24 25-29
Preoperative reason
Lost preoperativediagnosis,Misdiagnosis
A. Extreme lateral and multi-segmental lumbar disc herniation Lumbar highlight B. spinal stenosis, calcification of ligaments hyperplasia, breaking away from the posterior edge of psychosis and so on C. Associated with other segments of vertebral lesions, spinal tumor, sacral cyst and so on D. Enlargement of the spinal venous plexus
Three. Other
A. no strict aseptic technique to disc space infection B. Intradiscal endogenous chemical inflammatory stimulate dural sac and nerve root.
.
postoperative reason
Three. Lumbar instability:
A. Different posterior spinal surgical damage to the lumbar spine on the three-dimensional structure by varying degrees ,meanwhile, the dorsal branch of lumbar nerve injury pronely so innervation of the lower back muscle dysfunction. B. When the spinal structural instability,muscle hypertrophy, hyperplasia. While the waist was sustained muscle tension, small blood vessels under pressure, hypoxia, metabolite accumulation and stimulate location caused inflammatory , that generate soft tissue low back pain.
Intraoperative reason
One. Nerve compression retention:
A. Positioning error B. Retained prominent organization: the intervertebral disc tissue is not found in the nerve root canal and the posterior longitudinal ligament;the free,calcification of the intervertebral disc is not completely clear; Hypertrophy of the ligaments is not complete cleared. C. Decompression of nerve root canal is not completely. Trim around the nerve root canal is not thin. D. Excessive scraping disc space, resulting in bleeding.
Intraoperative reason
Two. Nerve injury: :
A.Ectopic nerve root or root malformation. .
B.Extremely narrow
C. Brutal surgery operations
Intraoperative reason
2
Inflammatory Inflammatory manifestations of intervertebral intervertebral
Treatment
A: Lumbar instability, oppression organizations continue to persist, positioning error: fusion and internal fixation B: Disc and then highlight: a. conservative treatment b simple discectomy or fusion and internal fixation C: Secondary to lateral recess stenosis: nerve root canal decompression and internal fixation D: Missed: one case of sacral cysts treated conservatively; a spinal cord tumor underwent tumor resection E: disc space infection: absolute bed rest, antibiotics, drainage of local counterparts，operation F: Imaging (-): conservative treatment and to enhance functional exercise
5 18 17 3
8 14 3
Therefore,by lumbar surgery syndrome patients treated ， and statistical analysis of medical history,symptoms and signs,imaging studies and surgical exploration data with the Japanese Orthopaedic Association(JOA) scoring low back pain. We had many reasons to get FBSS and grouped into the following three categories：