surgery for back pain
TRANSCRIPT
DISCECTOMY FOR DISC HERNIATION
Outcome
• DaySurgeryprocedure• backtosedentarydutiesin3weeks• backtosportin6weeks• goodorexcellentresultin90-95%
FUSION FOR LOW BACK PAIN
Resultsnotasgoodasfordeformityorinstability
Resultsnotasgoodasfordiscectomysurgery
WRONGdiagnosisWRONGpatient
FUSION FOR LOW BACK PAIN
DISEASE DIAGNOSISsymptoms and signs
Hx, Ex & Ix
TREATMENTCUREdirected at pathology
The medical model
DISEASE DIAGNOSISsymptoms and signs
Hx, Ex & Ix
The medical model
back pain is a complex symptom rather than a
discrete illness
structural lesion cannot be identified in many
cases
does not account for individual variation in
human response
15%
FUSION FOR LOW BACK PAIN
FUSION FOR LOW BACK PAIN
Resultsnotasgoodasfordeformityorinstability
Resultsnotasgoodasfordiscectomysurgery
WRONGdiagnosisWRONGpatient
SUITABLECANDIDATE• Self-employed• Successfulbusiness• Nospecificinjury• Nocompensationorlitigation• Workswithsomedifficulty• Hasgivenupsomeofmoreactivesports• Usesintermittentover-the-counteranalgesics• Non-smoker• Normalbodyweight• Goalistobeabletoreturntoactivelifestyle• Noabnormalillnessbehaviour
UNSUITABLECANDIDATE• Employeeundertakingmanualwork• Dissatisfiedwithemployment• Unremittingpainafterliftingatwork• UnresolvedWorkCover claimwithcivilactionpending
• Failedattemptsatreturntowork• Hasgivenupallsocialactivities• Usesregularnarcoticanalgesia• Smoker• Unfitandoverweight• Goalisforsomeonetogetridoftheirpain• Abnormalillnessbehaviour onexamination
remove the disc
Interbodyfusion
• remove the pain source• stop the movement
FUSION FOR LOW BACK PAIN
benefits
Anterior interbody
• anterior muscle-splitting only
• minimal tissue trauma
indications
• isolated degeneration• L5-S1 (L4-5)• no need to enter canal• thin, no previous major
abdominal surgery
FUSION FOR LOW BACK PAIN
benefits
Transforaminalinterbody
• allows nerve decompression
• allows all levels• familiarity
indications
• not suitable for ALIF• nerve compression esp
foraminal compression• correction of deformity
WhenisfusiongoodforLBP?•specificdiagnosis
•clearlydefinedpainsource
•suitablecandidate•nonegativepsychosocialfactors
•appropriatetechniqueforpathology•somesurgeonvariation