Failed back surgery syndrome: justification for reoperation based on clinical and CT/MRI findings

Abstract

The “failed back surgery syndrome” includes a variety of symptoms following disc surgery. In a prospective study 18 patients who met the criteria of the American Association of Neurological Surgeons (AANS) and American Academy of Orthopedic Surgeons (AAOS) for repeated lumbar spine surgery were examined by MRI and CT (before and after intravenous contrast medium). The findings were then compared with those at microsurgery. MRI produced correct diagnoses in 17 cases, CT in 13 cases. Recurrent disc herniation was responsible for the symptoms in 4 cases, epidural scar formation in 2. In 12 cases there was herniated disc material as well as epidural scar; disc material was preponderant 9 times, scar formation in 3 instances. Thus, MRI with i. v. gadolinium-DTPA appears to be most useful for the selection of patients who will benefit from repeated lumbar spine surgery, and superior to patient selection based upon the criteria of the AANS and AAOS.