Failed lumbar disc surgery requiring second operation. A long-term follow-up study.

Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.