FAILED LUMBAR-DISK SURGERY AND REPEAT SURGERY FOLLOWING INDUSTRIAL INJURIES

179 of the compensation patients in this study who had one low-back operation had to have repeat back surgery. 103 Workmen's Compensation Board patients who were reoperated on by a number of surgeons in the Toronto area were independently reviewed with one to two years of follow-up. Many had residual back pain, limited lumbar movement, persisting nerve-root deficits, and psychological disturbances. 40% Of the second operations were successful. Subsequent operations yielded progressively poorer results and made more patients worse than better. Operations were frequently undertaken without clear indications or evidence of correctable organic lesions. The results of repeat operations were better when the preceding operation had given more than 6 months' relief, when sciatica overshadowed back pain, and when a definite recurrent disc herniation was found. Scarring and neurolysis, previous infection, repair of a speudarthrosis, and adverse psychological factors precluded a good result. Careful patient selection based on total assessment of the disability including psychological assessment, accurate localization of the lesion by detailed investigation, and, most important, a logical sequence of decisions based on clear, objective criteria are prerequisites for this complex and demanding surgery. Caution and restraint are required when contemplating repeat back surgery.