Recurrent or persistent disc herniation Failed back syndrome

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ct scan image of large herniated disc in lumbar spine.


removal of disc @ 1 level can lead disc herniation @ different level @ later time. complete surgical excision of disc still leaves 30-40% of disc, cannot safely removed. retained disc can re-herniate sometime after surgery. virtually every major structure in abdomen , posterior retroperitoneal space has been injured, @ point, removing discs using posterior laminectomy/discectomy surgical procedures. prominent of these laceration of left internal iliac vein, lies in close proximity anterior portion of disc. in studies, recurrent pain in same radicular pattern or different pattern can high 50% after disc surgery. many observers have noted common cause of failed syndrome caused recurrent disc herniation @ same level operated. rapid removal in second surgery can curative. clinical picture of recurrent disc herniation involves significant pain-free interval. however, physical findings may lacking, , history necessary. time period emergence of new symptoms can short or long. diagnostic signs such straight leg raise test may negative if real pathology present. presence of positive myelogram may represent new disc herniation, can indicative of post operative scarring situation mimicking new disc. newer mri imaging techniques have clarified dilemma somewhat. conversely, recurrent disc can difficult detect in presence of post op scarring. myelography inadequate evaluate patient recurrent disc disease, , ct or mri scanning necessary. measurement of tissue density can helpful.


even though complications of laminectomy disc herniation can significant, recent series of studies involving thousands of patients published under auspices of dartmouth medical school concluded @ four-year follow-up underwent surgery lumbar disc herniation achieved greater improvement nonoperatively treated patients in primary , secondary outcomes except work status.








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