1. IPSILATERAL RADICULAR PAIN FOLLOWING DISCECTOMY K. Liaropoulos, P. Spyropoulou, P. Korovesis, Th. Maraziotis, N. Papadakis

2. FAILED BACK SURGERY SYNDROME (FBSS)   Refers to surgeries in the lumbar region of the spine for varying reasons (such as a herniated disc or spinal stenosis) and of various surgical techniques, without satisfactory improvement of symptoms.   The etiology is multifactorial   Its frequency reaches 10-40%

3. The development of a herniated disc at the same or another level of the same side and the consequent radicular syndrome, is in our opinion, a new nosological entity and the previous intervention should not be considered "failed", even if it relates indirectly, probably for reasons of biomechanical dynamics to the foregoing procedure.

4.   The term "failed back surgery syndrome" is the subject of this study, refers to cases of FBSS where re-operation was necessary due to persistence (or deterioration) or recurrence of the same radicular syndrome with the syndrome of the preoperative period of the first intervention which was performed by the same technique (open hemilaminectomy discectomy). It is part of the general FBSS with more specific and strict selection criteria.

5. OBJECT This study aims to: 1) investigate the etiology of the persistence or recurrence of the same radicular syndrome (the same root in the same side) in cases where re- operation was necessary. 2) investigate the relationship of gender, age and profession with persistence or recurrence of radicular pain. 3) investigate the correlation of time of occurrence of radicular pain

6. MATERIAL AND METHOD PERIOD: February. 1995 - January 2000 MATERIAL: 64 patients showed either persistence or recurrence of pre-operative symptoms During the same period 1016 patients had undergone surgery for a lumbar herniated disc They were studied in terms of:   medical history   objective neurological examination   imaging methods   surgical findings   postoperative findings

7. LOW BACK PAIN Common symptom (second in frequency after headache) 5% annual rate. Cause of activity limitation to adults under 45 years of age. Cause of loss of earnings and workers' compensation in the USA 14 billion US dollars annual cost for diagnosis and treatment. 1% accompanied by ischialgia, which in majority is due to a herniated intervertebral disc

8. ISCHIALGIA - LUMBAR HERNIATED DISC   85% of patients have a favorable result following conservative treatment, in average 6 weeks (rest, analgesics, physiotherapy)   15% of patients require surgical intervention In 8% -25% of cases, surgical treatment fails to relieve patients from pain or recurrence of symptoms after different than other times interval.

9. Table 1: Epidemiological characteristics of studied cases CHARACTERISTICSNUMBER OF CASESPERCENTAGE % GENDER  Men  Women 43 21 67 33 AGE < 20 20-50 > 50 0 39 25 0 61 39 PROFESSION  Farmers-Workers  Other 17 47 27 73 TOTAL 64 100

10. Table 2: Age-focused analysis of cases AGENUMBER OF CASES PERCENTAGE % <20 0 0 21- 30 3 5 31- 40 14 22 41- 50 22 34 51- 60 15 23 61- 70 6 9 >70 4 6 TOTAL64100

11. Table 3: Comparison of surgical findings and CT in 32 cases Recurrence of herniated disc19 /14 Epidural fibrosis3 / 8 Stenosis of lateral diverticulum + concretions 6 / 16 New projection at another level4 / 4

12. Table 4: Comparison of surgical findings and MRI in 46 cases Recurrence of herniated disc 17 /14 Epidural fibrosis 7 / 8 Stenosis of lateral diverticulum + concretions 18 / 16 New projection at another level 4 / 4

13. Table 5: Postoperative monitoring and epidemiological characteristics SUCCESSFULUNSUCCESSFUL NUMBER OF CASES %NUMBER OF CASES %TOTAL GENDER  WOMEN  MEN 18 34 85% 79% 3939 15% 21% 21 43 AGE  20-50  >50 32 20 82% 80% 7575 18% 20% 39 25 PROFESSION  FARMERS/WO RKERS  OTHER 16 36 89% 78% 2 10 11% 22% 18 46 TOTAL5281%1219%64

14. Table 6: The clinical profile of 64 patients BEFORE THE RE- OPERATION AFTER THE RE- OPERATION NUMBER OF CASES % % Motor deficit  No  Paresis 43 21 67% 33% 52 12 81% 17% Sensory deficit  No  Hypoaesthesia 4 60 6% 94% 11 53 15% 83% Reflexes  decreased or absent  Normal 38 26 59% 41% 29 35 46% 64%

15. Table 7: Surgical findings and results SUCCESSFULUNSUCCESSFUL ETIOLOGYNUMBER OF CASES %NUMBER OF CASES % Operated incorrect level 46 %00% Remaining disc 1016%00% Recurrence of herniated disc 1422%00% Stenosis of lateral diverticulum 58%1/53% Concretions 69%2/73% Stenosis of lateral diverticulum+concretio ns 914%7/1411% Pseudomeningomyeloce le 35%00% Permanent root trauma 00%1/12% Epidural hematoma 11%00% TOTAL5281%12/6419%

16. Table 8: Time of recurrence of symptoms and results TIME RESULTS SUCCESSFULUNSUCCESSFULTOTAL EXCELLENTVERYMODER ATE RELATIVE FAILURE ABSOLUTE FAILURE 1ST WEEK 13330120 2-4TH WEEK 0951015 1-6 MONTHS 0273517 6 MONTHS - 3 YEARS 0642012 TOTAL1320196664