IJOCP | Volume 2015| Issue – April 2015| Page
Conference: Poona Orthopaedic Society Annual Conference POSAC-2015,      India [Click for Full details]  


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Background: Commonest causes of failed back surgery are residual or new herniation, adhesions and foraminal stenosis missed or undertreated. Residual Back ache may also be from facetal causes or denervation and scarring of the paraspinal muscles. Original surgeon may advise his patient that nothing more can be done on the basis of post-op imaging and EMG and conduction velocity studies. This assessment may be inadequate and same old traditional solution which may be ineffective. Treatment of Failed back surgery by repeat traditional open revision surgery often incorporates more extensive decompression causing instability and necessitating fusion. The author having limited his practice to endoscopic MIS surgery report on the experience gained over the past 15-20 years to relieve the pain; by visualizing and treating residual and untreated andunrecognized causative patho-anatomy in FBSS.

Methods: 13 consecutive patients with FBSS with back and leg pain from a clinical and supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open translaminar surgical treatment for disc herniation or spinal stenosis.  Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for greater endoscopic visual confirmation of the affected roots and then decompress traversing and exiting nerve by decompressing the axilla, also known as the “hidden zone “ofMacnab. The average follow up time was, average 30 months, Minimum 12 months. Assessment at each visit included Macnab, VAS and ODIand gore sign.

Results: The average pre-operative VAS improved from 7.2 to 4.0, and ODI 48% to 31%.  While temporary dysesthesia occurred in 4 patients in the early post-operative period, all were happy, as all received additional relief of their pre-op symptoms. They were also able to avoid “open” decompression or fusion surgery.

Conclusions:  The transforaminal endoscopic approach is effective for FBSS due to recurrent HNP and lateral stenosis. Failed index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve, including the DRG which is located below the tip of SAP.10 The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilisation.11 It avoids going through the previous surgical site.

How to Cite this Abstract
 Managing Failed Back Surgery Under Local AnesthesiaInternational Journal of Conference Proceedings. March 2015;(2015):52