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

Theanalysisandpreventionoffailedbacksugerysyndrome WangxiyangDepartmentofSpinalSurgery XiangyaHospital CentralSouthUniversity Concept failedbacksugerysyndromefailedbacksugerysyndrome FBSS Isagroupofclinicalsymptomsthatduetomanyreasons Currently thegenerallyacceptedviewisthatafterlaminectomyordiscectomysurgery Patientswithlowbackpainorlegpaindidnotalleviateoreliminate evensymptomsincreasedornewsymptomsOccured Background Lumbardiseaseismostcommoninspinedisease inrecentyears matureandhighpenetrationoflumbarspinesurgery Follow upoflumbarspinesurgerythatcausedalackofsystemreports FBSSpatientsinthelumbarspinesurgeryintheincidencerateof5 to40 withanaverageof15 Researchpurposes Therefore bylumbarsurgerysyndromepatientstreated toanalyzethereasonsfortheFBSS providepreventionstrategiesandimprovethesatisfactionrateoflumbarspinesurgery GeneralInformation Time January2007 January2010Duration durationof1monthto5years theaveragedurationof3yearsCase Semi laminectomyin12cases laminectomyin9cases interbodyfusionpediclescrewfixationin22cases 23malesand20females aged11 70years mean39yearsoldSymptoms nosignificantimprovementinlimbsymptomsin6cases lowerextremityresidualpersistentlowbackpainin21cases Lowerbackmuscleweaknessin4cases halluxbackextensormuscleweaknessin3cases feverassociatedwithlowbackpainin3cases 6casesofcontralaterallowbackpain Imagingdata Treatment A Lumbarinstability oppressionorganizationscontinuetopersist positioningerror fusionandinternalfixationB Discandthenhighlight a conservativetreatmentbsimplediscectomyorfusionandinternalfixationC Secondarytolateralrecessstenosis nerverootcanaldecompressionandinternalfixationD Missed onecaseofsacralcyststreatedconservatively aspinalcordtumorunderwenttumorresectionE discspaceinfection absolutebedrest antibiotics drainageoflocalcounterparts operationF Imaging conservativetreatmentandtoenhancefunctionalexercise JOAscore Therefore bylumbarsurgerysyndromepatientstreated andstatisticalanalysisofmedicalhistory symptomsandsigns imagingstudiesandsurgicalexplorationdatawiththeJapaneseOrthopaedicAssociation JOA scoringlowbackpain WehadmanyreasonstogetFBSSandgroupedintothefollowingthreecategories Preoperativereason Lostpreoperativediagnosis MisdiagnosisA Extremelateralandmulti segmentallumbardischerniationLumbarhighlightB spinalstenosis calcificationofligamentshyperplasia breakingawayfromtheposterioredgeofpsychosisandsoonC Associatedwithothersegmentsofvertebrallesions spinaltumor sacralcystandsoonD Enlargementofthespinalvenousplexus One Nervecompressionretention A PositioningerrorB Retainedprominentorganization theintervertebraldisctissueisnotfoundinthenerverootcanalandtheposteriorlongitudinalligament thefree calcificationoftheintervertebraldiscisnotcompletelyclear Hypertrophyoftheligamentsisnotcompletecleared C Decompressionofnerverootcanalisnotcompletely Trimaroundthenerverootcanalisnotthin D Excessivescrapingdiscspace resultinginbleeding Intraoperativereason Two Nerveinjury A Ectopicnerverootorrootmalformation B ExtremelynarrowC Brutalsurgeryoperations Intraoperativereason Intraoperativereason Three OtherA nostrictaseptictechniquetodiscspaceinfectionB Intradiscalendogenouschemicalinflammatorystimulateduralsacandnerveroot postoperativereason One Lumbarintervertebraldiscoradjacentthediscofsegmentshighlight Afterdiscectomy Spinalbones muscleslosetheirbalancesystem leadtolumbarspinalinstability orbonegraftandinternalfixationofcompensatoryactivitiesbetweenadjacentsegmentsTwo Scarformation a Silkheadorbonechipsretained b Gelatinspongefilledorintraoperativeligationthread c fattytissueoverstripedorduraltissueadhesionisnotcompletelystripped d poordrainageordrainagetuberemovedprematurely e Earlypostoperative lackofactiveorpassiveexercise Pronetocausenerverootadhesion postoperativereason Three Lumbarinstability A Differentposteriorspinalsurgicaldamagetothelumbarspineonthethree dimensionalstructurebyvaryingdegrees meanwhile thedorsalbranchoflumbarnerveinjurypronelysoinnervationofthelowerbackmuscledysfunction B Whenthespinalstructuralinstability musclehypertrophy hyperplasia Whilethewaistwassustainedmuscletension smallbloodvesselsunderpressure hypoxia metaboliteaccumulationandstimulatelocationcausedinflammatory thatgeneratesofttissuelowbackpain postoperativereason Four InfectionA Delayedinfection Gainefindlumbarspinesurgeryinsomepatientswithdelayedunexplainedpaininthesurgicalarea LateOperativeSitePain LOSP mechanismmaybethedeepchroniclow gradeinfection theexactmechanismofthedeepinfectionisnotclear mayberelatedtopostoperativehematoma surgeryoperationspollution B Discspaceinfection postoperativereason Five Fixation A Pre screw rodbend Pre bendingrodfixedirrational notonlycannotrestorethespine snormalrangeor B fixationLoosened nailendstimulatethesofttissue postoperativereason Six Bonefusion pseudarthrosis A Poorintegrationorfusiontimeextended Long termstressmayleadtofixationfailureorscrew B PseudarthrosisFormed postoperativereason Seven Jointdegeneration A Smalljointdisorders secondaryspinalstenosisorlateralrecessstenosisandspinalinstability soneurologicalsymptomsappear B Sacroiliacjointdegeneration Afterfusionfixation especiallytheintegrationrangeincludedL5 S1 thesacroiliacjointmovementandbiomechanicsarealteredsignificantlyaftetrsurgery abnormalstressconcentrationacceleratedthesacroiliacjointdegenerationchroniclowerbackpainafteralongtime postoperativereason Eight contralaterallowbackpainA DischighlightagainB contralateralnucleuspulposuswasnotfoundandtheypressthenerveC Earlytransientnerverootpain oppressedspinalcerebrospinalrecoveredfluidperfusionafterthediscectomyofoneside Thisperfusionpressuretractthecontralateralnerverootandcauseittransientedema D PatientswithcentralcontralateralsymptomsareinseriousOrslightlybulgingsothesymptomswerecoveredE Secondaryspinalcanalornerverootcanalstenosis postoperativereason Nine otherCompoundregionalpainsyndrome crps Aclinicalsyndromethatappearstosevereintractable variabilityofpain sensorychanges abnormaltemperature Sweatglandsecretionsecondarytoacci