Failed back surgery syndrome: problems, pitfalls and prevention.
Several basic and fundamental principles remain prime considerations in lumbar spine surgery, so a review of these is appropriate in view of the current headlong rush into the use of new and developing technology for lumbar spine surgery. Eighteen hundred and sixty-one laminectomy procedures are reviewed, the majority of these for simple lumbar disc protrusion and spinal canal stenosis but also 204 cases where patients required a surgical procedure for failed back surgery syndrome. Surgical technique and technology will fail when an inappropriate patient is selected for surgical intervention; failure also occurs particularly in lumbar disc protrusion if lateral recess stenosis is undiagnosed and untreated at the time of surgery. The patient's motivation status also has a significant effect on surgical outcome and the optimum patient to submit to surgery for failed back surgery syndrome has sciatica, more severe than backache, a recurrent or residual disc protrusion associated with the stenosis and excellent motivation which is not affected by workers' compensation or other insurance claims or benefit.