腰椎手术失败综合征的原因评价与预防策略

The Reasons and Preventive Strategy for Failed Back Surgery Syndrome

目的 :对腰椎手术失败综合征 (FBSS)的发生原因进行分析和评价 ,为预防提供策略。方法 :5 4例FBSS住院接受再手术患者 ,进行术前休检、影像学检查和手术探查。结果 :FBSS的主要原因有 :( 1)椎间盘突出复发和邻近椎间盘突出。 ( 2 )椎管内瘢痕形成神经受压、中央性椎管狭窄。 ( 3)神经根减压不充分、侧隐窝狭窄。 ( 4 )腰椎不稳。 ( 5 )神经损伤。 ( 6 )创伤性小关节炎。 ( 7)手术节段错误。结论 :FBSS发生原因较多 ,大部分为医源性。术中细致操作、彻底减压 。

Objective:To analysis and to evaluate causes of failed back surgery syndrome (FBSS) for providing strategy of prevention of this syndrome.Methods:54 failed back surgery patients accepted physical examination ,image examination before re operation and exploration during operation.Results:The reasons for failed back surgery syndrome may be as follows:1)recurrent disc herniation,at the originally operated level or at other levels;2)cicatrization in vertebral canal compressed nerve root or causing central canal stenosis;3)inadequate surgical decompression on lateral recess stenosis:4)secondary instability;5)injuriy of nerve;6)traumatic arthritis;7)wrong location of surgical level.Conclusion:There were many reasons for failed back surgery syndrome most of them were iatrogenic origin.Refined manipulation,enough decompression during operation andgood rehabilitation are mainly preventive strategy of failed back surgery syndrome.