الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Failed back surgery syndrome (FBSS) is a term used to define an unsatisfactory outcome of a patient who underwent spinal surgery irrespective of type or intervention area with persistent pain in the lumbosacral region with or without it radiating to the leg.
This syndrome can be categorized as follows: mistaken diagnosis, trans operative error, technique error, poor application, poor indication.
The operative technique in the treatment of lumbar disc herniation has been perfected, so success can be expected in most patients undergoing disc surgery. However, the results after discectomy are sometimes unsatisfactory and back and/ or sciatic pain may be recurrent or increased. For example, standard open discectomy is associated with a 10% to 15% failure rate.
The causes of failure are many, either insufficient neural decompression, surgery at the wrong level, traumatization of the nerve root, persistent lateral and/or central spinal stenosis, segmental instability, etc. Wrong surgical indication, wrong preoperative diagnosis, and wrong surgical planning will also lead to the failure of surgery.
The rate of recurrent disc herniation after lumbar discectomy is 6 to 14%, These recurrences are currently not totally predictable by objective studies and probably related to immeasurable factors in human beings: the mechanics of the disc space and tension in the outer wall of the disc, etc.
The history is the most important part in the initial evaluation of the patients. The patient with lumbar inter-vertebral disc herniation will present with one or both of two basic symptom complexes, mainly; the acute symptoms and the chronic symptoms, also in some patients, a rare presentation may be demonstrated which is the cauda equina syndrome.
CT, MRI and nuclear medicine have critical diagnostic roles in evaluation of failed back surgery syndrome characterized by symptomatic new or recurrent disc herniation, peri-/epidural fibrosis, arachnoiditis and radiculitis.