Analysis of failures and poor results of lumbar spine surgery

The failures and poor results of lumbar spine surgery are analyzed in a retrospectively study of 105 consecutive patients referred to the authors for evaluation during 1976. Those who had a history of industrial or vehicular accident outnumbered others by about two to one. Review of histories, physical findings, and myelograms in most of the patients failed to substantiate the diagnosis of ruptured disc or nerve root compression. Many of the failures occurred in thos patients in whom little if any evidence of nerve root compression was found. The indications for surgery were poor in this group. Other failures occurred in patients who had improper, incomplete, or inadequate operations, especially those with lumbar spondylosis, a retained fragment of disc, or surgery at the wrong level. In addition to failure, poor results were recorded in patients who had significant nerve root or cauda equina injury from surgery, associated "arachnoiditis" which is thought to result from surgical trauma in many instances, or multiple operations leading to a hopelessly disabled state.