Failed surgical treatment for lumbar stenosis: Principles of revision surgery

Continued or worsening symptoms following surgical decompression for lumbar spinal stenosis may be seen in 10% to 200% of surgically treated candidates. Factors that may contribute to a less than favorable surgical outcome include poor patient selection, patient comorbidities, inadequate decompression, unrecognized instability, and postoperative complications. An organized approach focusing on the temporal relation of the patient's symptoms to the index procedure, the patient's response to various treatment modalities, and pertinent diagnostic studies may assist in selecting appropriate candidates for a revision surgical procedure. With appropriate surgical indications and after an adequate period of nonsurgical care, patients may experience satisfying relief of lower extremity discomfort following surgical decompression for spinal stenosis.