[Indications for and choice of reintervention in failed back operations]

Is it true that even today, the results of reinterventions after unsuccessful spine surgeries are often unsatisfactory, despite major diagnostic and therapeutic advances in the field of spinal surgery. Based on our observations of cases with failed back surgery syndrome in the Department of Orthopaedic Surgery, the University of Balgrist Zürich, the indications for a reintervention and the choice of the surgical procedure are reported. The use of decompression as re-intervention is successful only in cases where there is an unequivocally demonstrable lack of space for the nervous system due to recurrent hernia or narrow spinal canal. In such cases it may be possible, subject to careful assessment of the criteria, to perform a percutaneous nucleotomy as an alternative to a conventional microsurgical discectomy. Nowadays decompression by means of instrumental spinal fusion is usually indispensable as re-intervention after unsuccessful surgeries.