INTRODUCTION: Patients with multiply operated back (MOB) may suffer from persistent low back pain (LBP) associated with back muscle damage and epidural fibrosis following repeated back surgery (Failed Back Spinal Syndrome). Anterior spinal fusion surgery and lateral lumbar interbody fusion (LLIF) is considered to be favorable for MOB patients. However, it’s few scientific research for this issue due to the variety pathogenesis.
AIM: To compare the clinical results of MOB patients and first-time surgery patients who underwent LLIF for lumbar spinal stenosis with degenerative scoliosis and degenerative spondylolisthesis with instability.
METHODS: LLIF was performed for lumbar spinal stenosis with spinal instability in 53 consecutive cases of single hospital (29 males, 24 females, average age 69 years). Clinical outcomes were compared between the MOB patient group (MOB group) and the first surgical patient group (F group). We evaluated JOA Back Pain Evaluation Questionnaire (JOABPEQ) and JOA scores before and 2 years after surgery. MOB patients are defined as those who have had one or more lumbar surgery on the same intervertebral or adjacent vertebrae in the past.
RESULTS: There were 18 cases (11 males, 7 females, average 71 y-o.) in MOB group, and 35 cases (males: 19 cases, females: 16 cases, average 68 y-o.) in F group. There was no significant difference between the two groups in age, sex, number of intervertebral fusion, Modic change of fused intervertebral end plate, score of brief scale for evaluation of psychiatric problem, lumbar lordosis, and sagittal vertical axis before and after surgery. The preoperative JOA scores averaged 12.5 points in MOB group, and averaged 11.6 points in the F group. The postoperative JOA scores averaged 23.9 points in MOB group, averaged 24.7 points in the F group. The preoperative JOABPEQ averaged 36.3 points in MOB group and averaged 35.4 points in the F group. The postoperative average JOA score was 75.4 in MOB group and 70.2 in the F group.
DISCUSSION: Based on the results of this comparison between MOB patients and first-time surgery patients, there was no significant difference in clinical results, and there was no new residual low back pain. It was considered that LLIF is one of the options for the patients with MOB.