Clinical outcomes of revision lumbar spinal surgery: 124 patients with a minimum of two years of follow-up.

BACKGROUND Pertinent literature on revision lumbar spinal surgery has revealed a wide variation in success rates, ranging from 12% to 82%. In addition, a solid consensus has not yet been reached on its positive factors. We retrospectively reviewed 124 consecutive patients who underwent revision lumbar spinal surgery and investigated the factors that affected the outcomes of their surgery. METHODS Revision lumbar spinal surgery was performed in 124 patients from January 1992 to December 1996, with an average follow-up of 37.6 months (range, 24-89 months). The various factors analyzed included age, gender, previous diagnosis, number of previous operations, period of pain-free interval, neurologic deficit, operative procedure, and fusion status. This analysis revealed the effect of each factor on the overall results. Radiographs were obtained, and patients were assessed during the final follow-up or by questionnaire. RESULTS The success rate of revision lumbar spine surgery in this study was 83.9%. Successful outcomes were significantly associated with the spinal procedure with fusion and with union of the spinal fusion. Patients with defined mechanical instability had better results than did those with stenosis only. In addition, the complication rate for repeated lumbar spinal surgery was 9.6% and major complications attributed to poor results. CONCLUSION This study reveals a high success rate of revision spinal surgery. We recommend performing spinal fusion, and achievement of solid fusion in repeated low back surgery is invaluable for patients with spinal instability. Targeting the specific pathology of failed back surgery syndrome is crucial in attaining satisfactory results with revision lumbar spinal surgery.