[Pain syndrome relapse following herniated disc surgery (diagnosis and treatment)]

The aim of this study was to improve results of treatment of patients with degenerative disc disease at the long-term period after microdiscectomy by developing unique algorithm for diagnosis and treatment of persisting pain syndrome. Patients were divided into two groups. First one included 198 patients with reflex-pain syndromes. In the main subgroup (97 patients) consecutive denervation of spinal facet joints and intervertebral discs was performed to detect referred-pain syndromes. The second group included 64 patients who suffered recurrent nerve-root compression. The main cause was relapse of disc herniation. We used anterior retroperitoneal approach in 34 patients to remove herniated disc and stabilize the segment. Surgery results were assessed by visual-analogue scale and Oswestry index. Consecutive chemical denervation of spinal facet joints and intervertebral discs allowed not only to discover referred-pain syndromes, but enabled to control them. Stepwise surgical treatment resulted in clinical recovery and better outcome in 88.7% of our patients. Decompressive-stabilizing surgery with anterior interbody fusion is a pathogenetic and technically adequate treatment. The long-term follow up results of surgical treatment were better at the group of our patients operated with anterior retroperitoneal approach and anterior foraminotomy. Excellent and good results were obtained at 79.3% cases.