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Repeat decompression of lumbar nerve roots. A prospective two-year evaluation
1Department of Orthopaedics, University Hospital, Lund, Sweden.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1993
Summary
Repeat lumbar decompression surgery can alleviate persistent back and leg pain, especially when caused by recurrent disc herniation or spinal stenosis. However, outcomes are less favorable for sciatica stemming from nerve-root scarring.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Persistent or recurrent back and leg pain often necessitates revision surgery after initial lumbar spinal procedures.
- Previous operations commonly include discectomies or decompression for spinal stenosis.
Purpose of the Study:
- To evaluate the efficacy of repeat decompression surgery for persistent or recurrent lumbar pain.
- To identify factors influencing outcomes in patients undergoing revision spinal surgery.
Main Methods:
- Prospective study of 93 patients undergoing repeat lumbar decompression.
- Follow-up for two years using a four-scale grading system to assess surgical outcomes.
- Intraoperative findings documented, including disc herniation, spinal stenosis, and periradicular fibrosis.
Main Results:
- Repeat decompression showed significant success in cases of nerve-root compression from recurrent disc herniation or bony stenosis.
- Outcomes for single nerve-root compression were comparable to primary operations.
- Limited improvement was observed for sciatica attributed to nerve-root scarring.
Conclusions:
- Repeat lumbar decompression is effective for specific causes of persistent pain, such as recurrent disc herniation and spinal stenosis.
- Diagnosis at repeat surgery is a critical determinant of successful outcomes.
- Revision surgery for nerve-root scarring yields poor results, suggesting alternative management strategies may be needed.