Burton C V, Kirkaldy-Willis W H, Yong-Hing K, Heithoff K B
Clin Orthop Relat Res. 1981 Jun(157):191-9.
An interinstitutional study on the failed back surgery syndrome (FBSS) has determined that failure to recognize or adequately treat lateral stenosis of the lumbar spine with resultant nerve irritation and/or compression comprised the primary etiology in 57% to 58% of patients. Other common causes were recurrent or persistent disk herniation and lumbosacral adhesive arachnoiditis. The diagnosis of stenosis was made either by high-resolution CT scan of the lumbar spine or by directly testing lateral canal and for animal patency at the time of surgery. It is now appreciated that the process of degenerative disk disease, particularly when enhanced by diskectomy, results in progressive loss of intervertebral disk volume and predisposes to future ipsilateral or contralateral lateral spinal stenosis. Degenerative disk disease is ultimately a bilateral process and therefore surgical exposure should be bilateral. The direct and indirect costs of FBSS to patients and to society as well as the toll in human suffering are very high. This is particularly a matter of concern when it is realized that for many FBSS patients, surgery could have been avoided in the first place by preventive care or by innovative conservative treatment. When surgery is indicated, adequate diagnostic tests and the execution of appropriate procedures based upon this information should largely prevent the failed back surgery syndrome.
一项关于腰椎手术失败综合征（FBSS）的机构间研究表明，未能识别或充分治疗腰椎侧隐窝狭窄并导致神经刺激和/或压迫，是57%至58%患者的主要病因。其他常见原因包括复发性或持续性椎间盘突出以及腰骶部粘连性蛛网膜炎。腰椎狭窄的诊断通过腰椎高分辨率CT扫描或在手术时直接检测侧隐窝和椎间孔通畅情况来进行。现在人们认识到，椎间盘退变疾病的过程，特别是在椎间盘切除术后加剧时，会导致椎间盘体积逐渐丧失，并易引发未来同侧或对侧的腰椎侧隐窝狭窄。椎间盘退变疾病最终是一个双侧过程，因此手术显露应该是双侧的。FBSS给患者和社会带来的直接和间接成本以及给人类带来的痛苦代价非常高昂。当意识到对于许多FBSS患者来说，通过预防性护理或创新性保守治疗本可首先避免手术时，这尤其令人担忧。当需要进行手术时，充分的诊断测试以及基于这些信息执行适当的手术程序应能在很大程度上预防腰椎手术失败综合征。
