Algorithm for salvage surgery of the lumbar spine.

An explicit and effective plan for evaluation of the failed back allows the diagnosis of nonorthopedic causes for low back pain, whether they be medical or psychosocial in nature. This plan includes the prompt recognition and treatment of those problems which are surgically remediable, such as the recurrent disk herniation or spinal stenosis. Finally, this plan will accurately define those patients for whom there is no cure at the present time, such as those with arachnoiditis and those with low back pain without a definable cause. Careful adherence to this plan will prevent the physician from advising these unfortunate patients who already suffered one unsuccessful operation from undergoing yet another futile exercise and yet not exclude those who will benefit from operative intervention.