腰椎手术失败综合征的原因评价与预防策略

目的：对腰椎手术失败综合征（FBSS）的发生原因进行分析和评价，为预防提供策略。方法：54例FBSS住院接受再手术患者，进行术前体检、影像学检查和手术探查。结果：FBSS的主要原因有：（1）椎间盘突出复发和邻近椎间盘突出。（2）椎管内瘢痕形成神经受压、中央性椎管狭窄。（3）神经根减压不充分、侧隐窝狭窄。（4）腰椎不稳。（5）神经损伤。（6）创伤性小关节炎。（7）手术节段错误。结论：FBSS发生原因较多，大部分为医源性。术中细致操作、彻底减压，术后良好康复是主要的预防策略。

The Reasons and Preventive Strategy for Failed Back Surgery Syndrome

Objective:To analysis and to evaluate causes of failed back surgery syndrome (FBSS) for providing strategy of prevention of this syndrome.Methods:54 failed back surgery patients accepted physical examination ,image examination before re operation and exploration during operation.Results:The reasons for failed back surgery syndrome may be as follows:1)recurrent disc herniation,at the originally operated level or at other levels;2)cicatrization in vertebral canal compressed nerve root or causing central canal stenosis;3)inadequate surgical decompression on lateral recess stenosis:4)secondary instability;5)injuriy of nerve;6)traumatic arthritis;7)wrong location of surgical level.Conclusion:There were many reasons for failed back surgery syndrome most of them were iatrogenic origin.Refined manipulation,enough decompression during operation andgood rehabilitation are mainly preventive strategy of failed back surgery syndrome.