Sen K K, Singh Amarjit
Reader, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411 040.
Professor and Head, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411 040.
Med J Armed Forces India. 1999 Apr;55(2):133-138. doi: 10.1016/S0377-1237(17)30269-1. Epub 2017 Jun 26.
The failed back surgery syndrome (FBSS) is a severe, long-lasting, disabling and relatively frequent (5-10%) complication of lumbosacral spine surgery. Wrong level surgery, inadequate surgical techniques, vertebral instability, recurrent disc herniation, and lumbosacral fibrosis are the most frequent causes of FBSS. The results after repeated surgery on recurrent disc herniations are comparable to those after the first intervention, whereas repeated surgery for fibrosis gives only 30-35% success rates, and 15-20% of the patients report worsening of the symptoms. MRI has allowed a differentiation between these two pathologies for selection of different therapies. Gadolinium enhanced MR is at present the single most sensitive and specific imaging modality available to the neuro radiology imager for the evaluation of the post operative lumbosacral spine in the patient presenting with FBSS. Medical imaging specialists and clinicians need to better understand the origins and means of avoiding the FBSS, to more clearly focus the post operative imaging evaluation and to more successfully link the clinical diagnosis and the imaging findings with optimised patient therapy.
腰椎手术失败综合征（FBSS）是腰骶部脊柱手术一种严重、持久、致残且相对常见（5%-10%）的并发症。手术节段错误、手术技术不完善、椎体不稳、复发性椎间盘突出和腰骶部纤维化是FBSS最常见的病因。复发性椎间盘突出症再次手术后的效果与首次干预后的效果相当，而针对纤维化的再次手术成功率仅为30%-35%，且15%-20%的患者报告症状恶化。磁共振成像（MRI）有助于区分这两种病理情况，以便选择不同的治疗方法。钆增强磁共振成像目前是神经放射成像师用于评估出现FBSS的患者术后腰骶部脊柱的最敏感、最特异的单一成像方式。医学影像专家和临床医生需要更好地了解FBSS的病因及避免方法，更明确地聚焦术后影像评估，并更成功地将临床诊断和影像结果与优化的患者治疗联系起来。
