Analysis of the Causes for Failed Lumbar Disc Herniation Surgery and the Methods of Reoperation

[Objective]To analyze the causes for failed lumbar disc herniation surgery,and investigate the methods of reoperation.[Methods]The clinical data of the 33 patients with failed lumbar disc herniation surgery and reoperation requested were analyzed retrospectively.The clinical efficacy was evaluated by revised Macnab system,JOA scores before reoperation and the latest follow-up after reoperation and radiographic findings.[Results]The causes of failed surgery included recurrent lumbar disc herniation(17 cases),adjacent lumbar disc herniation(5 cases),postoperative segmental instability(7 cases) and incomplete lumbar discectomy(4 cases).And there were 7 cases with coexisting secondary spinal canal stenosis and 4 cases with epidural scar formation among them.Four patients with cerebrospinal fluid leakage during surgery and 1 case with unilateral transient lower extremity paresthesia after operation recovered better.All the cases were followed up from 24 to 52 months after reoperation(34.8 months on average).The clinical results were assessed according to revised Macnab system as excellent in 11 cases,good in 15,fair in 6 and poor in 1,the excellent and good rate was 78.80%.The JOA score averaged 11.2 points before reoperation,and the latest followed-up JOA increased to 25.4 points after reoperation(P0.05),with the mean recovery rate of 79.80%.Twenty cases obtained posterolateral fusion,and 2 cases got interbody fusion,and the fusion rate was 86.40%.[Conclusion]Recurrent lumbar disc herniation,adjacent lumbar disc herniation,postoperative segmental instability and incomplete lumbar discectomy are the main causes of failed surgery.If the causes of failed surgery are analyzed correctly and the types of surgery selected reasonably,satisfactory effect could be obtained.