Introduction– Post Laminectomy syndrome, previously known as “ Failed Back Syndrome” has been one of the most controversial and difficult situations confronting spine surgeons till date. There has been no established protocol for approaching patients with post laminectomy syndrome. In this study we aim to give an algorithmic approach towards management of post laminectomy syndrome that will help lay down guidelines for better treating this condition and decrease the revision rates and improve the functional outcome.
Material and Methods: This was a retrospective and prospective study conducted in our institute form MAY 2011 to MAY 2013. Patients selected as per inclusion and exclusion criteria were assessed pre and post operatively using functional scoring system that included VAS ,SF36 ,ODI SCORE and fusion was assessed radiographically using the Brantigan Steffee Fraser score every three months until upto 1 year.This protocol was approved by Institutional Review Board.
Observation and Results: In our study of 50 patients, we had 24 females (48%) and 26 males (52%) The mean age of the patients who undervent operations was 51.73 years (51.73 ± 20.27 years). 16% (n = 8) patients had a pre-operative neurodeficit. The rest of the patients had progressively worsening back and leg pains. In our study we observed that cause of failure of the previous or index surgery was Type 1 failure (recurrent disc herniation) in 20% (n=10) of cases, Type 2 failure (instability and restenosis) in 64% (n=32) of cases, of a total of 50 cases. Type 3 failure (Adjacent segment degeneration) was a cause of failed back syndrome in 16% cases (n=8). ASD, however, is studied over longer period of time and hence a limitation to our study of 1 year. We had one patient with Type 4 failure (loosening of pedicle screw innie) who had no symptoms and hence was treated conservatively. In our series we found a significant difference between the functional outcome pre op and and post op 1 year using SF36 score (90 ± 1.76 and 100 ± 1.00 respectively, p<0.001 ) and Oswestry disability index (55% and 21% respectively). We also found significant improvement on the VAS scoring for leg pain (6 ± 0.47 and 2 ± 0.52 respectively; p<0.001 ) and VAS for back pain (5.00 ± 0.76 and 1.00 ± 0.18 respectively; p< 0.001). Also there was a significant improvement on the Physical Component Survey pre op and post op 1 year (27.16 ± 8.01 and 56.19 ± 1.83 respectively; p<0.001 ) and Mental component survey (36.72 ± 11.69 and 58.87 ± 2.97 respectively; p<0.001). We also did not see any evidence of adjacent segment degeneration that was assess using Brantigan, Steffee, Fraser classification. In our case study, all patients had achieved grade 2 fusion as per this classification.
Discussion: We attempt to provide an algorithmic approach for the cases as per their causes after assessing their functional outcomes. Pertinent literature on revision lumbar spinal surgery has revealed a wide variation in success rates, ranging from 12% to 82%. However, recent literature suggest good surgical outcome following surgical intervention and the two most important criteria for success in revision spine surgery are the right selection of patients and adoption of proper technique in the hands of an experienced spine surgeon. Such surgeries are technically demanding, with complication rates reported to be around 9.6% overall. Adjacent segment degeneration has been studied over a period of 5 years or more in many studies. Since we are following up patients for only once year, this is a limitation to our study.
Conclusion: We have put forth an algorithmic approach for the management of the post laminectomy syndrome by segregating the patients into types of failures, which will provide for guidelines for better and successful management of these patients and that gives good functional outcomes. However, further study in required in terms of long term follow up.
How to Cite this Abstract
Chikle C, Khurjekar K, Hadgaonkar S, Sancheti P, Shyam A. Management algorithm and short term outcomes in operated cases of “FAILED BACK SYNDROME.I J Orthopaedic Conference Proceedings April 2014;1(2):8.