Slipman Curtis W, Shin Carl H, Patel Rajeev K, Isaac Zacharia, Huston Chris W, Lipetz Jason S, Lenrow David A, Braverman Debra L, Vresilovic Edward J
Penn Spine Center, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104, USA.
Pain Med. 2002 Sep;3(3):200-14; discussion 214-7. doi: 10.1046/j.1526-4637.2002.02033.x.
Retrospective chart review.
To report the epidemiologic data of nonsurgical and surgical etiologies of failed back surgery syndrome (FBSS) from two outpatient spine practices.
FBSS has been offered as a diagnosis, but this is an imprecise term encompassing a heterogeneous group of disorders that have in common pain symptoms after lumbar surgery. The current literature primarily diagnoses for the various etiologies of FBSS from a surgical perspective. To our knowledge, there is no study that investigates the myriad of surgical and nonsurgical diagnoses from a nonsurgical perspective.
Specific inclusion and exclusion criteria were developed for a list of 42 nonsurgical and surgical differential diagnoses of FBSS. The determination of which category, surgical or nonsurgical, each diagnosis was placed into depended upon the categorization of those diagnoses in previously published literature on FBSS. Each of the authors reviewed the definitions, and they came to a unanimous agreement on each diagnosis' inclusion and exclusion criteria. Data extraction was then carried out in each of the two involved institutions by using the key words discectomy, laminectomy, and fusion to identify all the patients who had any combination of low back, buttock, or lower extremity pain after lumbar discectomy surgery. These charts were then individually reviewed to extract epidemiologic data.
A total of 267 charts were reviewed. One hundred and ninety-seven (197) charts had a complete workup. Of these, 11 (5.6%) had an unknown etiology, and 186 had a known diagnosis. Twenty-three (23) various diagnoses were identified. There was approximately an equal distribution between the incidences of nonsurgical and surgical diagnoses; 44.4% had nonsurgical diagnoses and 55.6% had surgical diagnoses. The most common diagnoses identified were spinal stenosis, internal disc disruption syndrome, recurrent/retained disc, and neural fibrosis.
FBSS is a syndrome consisting of a myriad of surgical and nonsurgical etiologies. Approximately one half of FBSS patients have a surgical etiology. Approximately 95% of patients can be provided a specific diagnosis.
回顾性病历审查。
报告来自两家门诊脊柱诊疗机构的腰椎手术失败综合征（FBSS）非手术和手术病因的流行病学数据。
FBSS一直作为一种诊断，但这是一个不精确的术语，涵盖了一组异质性疾病，这些疾病的共同特征是腰椎手术后出现疼痛症状。当前文献主要从手术角度对FBSS的各种病因进行诊断。据我们所知，尚无研究从非手术角度调查众多的手术和非手术诊断。
针对FBSS的42种非手术和手术鉴别诊断制定了具体的纳入和排除标准。每个诊断归入手术或非手术类别取决于之前关于FBSS的文献中对这些诊断的分类。每位作者都审查了定义，并就每个诊断的纳入和排除标准达成了一致。然后在两家相关机构中，通过使用关键词椎间盘切除术、椎板切除术和融合术来识别所有在腰椎间盘切除术后出现腰、臀部或下肢疼痛的患者，从而进行数据提取。然后对这些病历逐一进行审查以提取流行病学数据。
共审查了267份病历。其中197份病历有完整的检查记录。在这些病历中，11份（5.6%）病因不明，186份有明确诊断。共确定了23种不同诊断。非手术和手术诊断的发生率大致相等；44.4%为非手术诊断，55.6%为手术诊断。最常见的诊断为椎管狭窄、椎间盘内紊乱综合征、复发性/残留椎间盘及神经纤维瘤病。
FBSS是一种由多种手术和非手术病因组成的综合征。约一半的FBSS患者有手术病因。约95%的患者能够得到明确诊断。
