Recurrent lumbar spinal stenosis: Etiology and surgical management

Surgery for lumbar spinal stenosis (LSS) is commonly performed and generally results in substantial symptom relief. Unfortunately, recurrent stenosis develops in many cases, which can lead to regression of functional gains achieved from the index surgery. Recurrent stenosis can arise from a variety of mechanisms and presents with a broad spectrum of symptoms. In those cases that are recalcitrant to nonoperative treatment, revision decompression surgery may be elected, sometimes involving fusion and/or stabilization. Revising a previously operated segment can be a challenging prospect. Attention must be paid toward achieving the correct diagnosis and subsequently developing the most effective surgical plan. Among these considerations, the spinal surgeon must decide which levels and anatomic locations are responsible for recurrent symptoms, whether or not fusion is indicated to address instability, and which techniques are most safely and effectively used. Adhering to sound diagnostic and technical principles, surgery for recurrent stenosis can be performed safely with a reasonably high rate of symptomatic relief. For a variety of reasons, the incidence of complications can be higher than with index surgery, such as dural tears and wound infections. Vigilance and early recognition can help limit any adverse impact on overall outcome.