Cause analysis and rehabilitation therapy of failed back surgery syndrome

GUO Xian-feng; ZHOU Shu-na; LI Xu

doi:10.3969/j.issn.2095-252X.2014.09.008

Abstract：Objective To investigate the main causes and rehabilitation effects of failed back surgery syndrome ( FBSS ).Methods From October 2007 to May 2014, 46 patients with FBSS were treated in Beijing Jishuitan Hospital and Beijing Zhanlanlu Hospital in Xicheng District. There were 32 males and 14 females, whose average age was 44.6 years old ( range: 25-62 years ). Spine surgeons ruled out the indications of reoperation. According to the etiological factors, an individualized and comprehensive rehabilitation therapy was applied. The Japanese Orthopedic Association ( JOA ) score was used to assess low back pain before and after the treatment, and the improvement rate was calculated. The standards set by the spine surgery group of Chinese Medical Association were used to evaluate the symptoms before the treatment ( low back pain and lower limb pain ), lumbar range of motion ( ROM ), straight leg raising test, nerve function ( motor and sensory functions ). Lumbar spinal stability was assessed in the weak chain test.Results After rehabilitation treatment, the JOA score was increased from ( 12.8±3.9 ) points before the treatment to ( 21.7±4.6 ) points (P<0.05 ), and the clinical improvement rate was 54.9%. There were 22 excellent cases and 18 good cases. In the weak chain test, 40 patients were found to be positive before the treatment. And at the end of the treatment, the positive results disappeared in 26 patients, were improved in 10 patients and did not change in 4 patients. The causes in the patients with FBSS who did not need a revisional operation could be divided into 4 types, including improper selection of surgical indications, errors in surgical procedures, improper postoperative rehabilitation measures and operation-related factors that gradually led to disease progression.Conclusions It is very important to actively and reasonably apply the individualized and comprehensive rehabilitation therapy in the treatment of the patients with FBSS. For the patients with FBSS that is mainly caused by lumbar segmental instability, satisfactory effects can be achieved when the individualized and comprehensive rehabilitation therapy is adopted with the sling exercise therapy predominated. The cause of lumbar diseases is complex. Therefore, different treatment methods should be carefully chosen depending on the different etiological factors, so as to reduce the occurrence of FBSS.