gms | German Medical Science

Objective: To describe the incidence and the causes of immediate failures of lumbar microdiscectomy (immediate failed back surgery syndrome, iFBSS), to define the value of radiological imaging for identification of the underlying pathology, and to propose a management algorithm.

Method: iFBSS was defined as persistance, deterioration, recurrence (during hospital stay) of radicular pain and/or sensomotor deficit and/or sphincter dysfunction after microdiscectomy, which was uneventful from the surgeon's perspective. The medical records of 1546 patients undergoing discectomy for mediolateral lumbar disc herniations were screened for iFBSS. The pre- and postoperative imaging, operation records, therapy and the outcome of patients with iFBSS were reviewed.

Results: Forty-four of 1546 patients (2.8%) with iFBSS were identified. All patients underwent re-operation, and overseen disc material/re-herniation (n=22), epidural hematoma (n=6), inadequate decompression of accompanying recessal stenosis (n=2) and dural tear with fascicle herniation (n=1) were found to be causative. In 13 patients, no clear pathology was seen intraoperatively and a battered root syndrome (nerve root swelling due to excessive surgical manipulation) was diagnosed. Neuroradiological imaging established the correct diagnosis in 25 of 43 radiologically investigated patients (57%).

Conclusions: The radiological work up we used was of limited value for the correct differentiation of the various aetiologies of iFBSS. Therefore, the authors believe that the treatment strategy should strongly rely on the clinical presentation. To avoid unnecessary surgery in cases of battered root syndrome, we propose to proceed to reoperation only in patients with new or with persistent radiculopathy despite adequate antiedematous medical therapy.