Spinal stenosis Failed back syndrome

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ct scan of laminectomy showing scar formation (highlighted in red)causing new stenosis.


spinal stenosis can late complication after laminectomy disc herniation or when surgery performed primary pathologic condition of spinal stenosis. in maine study, among patients lumbar spinal stenosis completing 8- 10-year follow-up, low pain relief, predominant symptom improvement, , satisfaction current state similar in patients treated surgically or nonsurgically. however, leg pain relief , greater back-related functional status continued favor receiving surgical treatment.


a large study of spinal stenosis finland found prognostic factors ability work after surgery ability work before surgery, age under 50 years, , no prior surgery. long-term outcome (mean follow-up time of 12.4 years) excellent-to-good in 68% of patients (59% women , 73% men). furthermore, in longitudinal follow-up, result improved between 1985 , 1991. no special complications manifested during long-term follow-up time. patients total or subtotal block in preoperative myelography achieved best result. furthermore, patients block stenosis improved result in longitudinal follow-up. postoperative stenosis seen in computed tomography (ct) scans observed in 65% of 90 patients, , severe in 23 patients (25%). however, successful or unsuccessful surgical decompression did not correlate patients subjective disability, walking capacity or severity of pain. previous surgery had strong worsening effect on surgical results. effect clear in patients total block in preoperative myelography. surgical result of patient previous surgery similar of patient without previous surgery when time interval between last 2 operations more 18 months.


post-operative mri findings of stenosis of limited value compared symptoms experienced patients. patients perception of improvement had stronger correlation long-term surgical outcome structural findings seen on postoperation magnetic resonance imaging. degenerative findings had greater effect on patients walking capacity stenotic findings


postoperative radiologic stenosis common in patients operated on lumbar spinal stenosis, did not correlate clinical outcome. clinician must cautious when reconciling clinical symptoms , signs postoperative computed tomography findings in patients operated on lumbar spinal stenosis.


a study georgetown university reported on one-hundred patients had undergone decompressive surgery lumbar stenosis between 1980 , 1985. 4 patients postfusion stenosis included. 5-year follow-up period achieved in 88 patients. mean age 67 years, , 80% on 60 years of age. there high incidence of coexisting medical diseases, principal disability lumbar stenosis neurological involvement. there high incidence of success, recurrence of neurological involvement , persistence of low-back pain led increasing number of failures. 5 years number had reached 27% of available population pool, suggesting failure rate reach 50% within projected life expectancies of patients. of 26 failures, 16 secondary renewed neurological involvement, occurred @ new levels of stenosis in 8 , recurrence of stenosis @ operative levels in eight. reoperation successful in 12 of these 16 patients, 2 required third operation. incidence of spondylolisthesis @ 5 years higher in surgical failures (12 of 26 patients) in surgical successes (16 of 64). spondylolisthetic stenosis tended recur within few years following decompression. because of age , associated illnesses, fusion may difficult achieve in group.








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