surgery for back pain
TRANSCRIPT
DISCECTOMY FOR DISC HERNIATION
Outcome
• Day Surgery procedure • back to sedentary duHes in 3 weeks • back to sport in 6 weeks • good or excellent result in 90-‐95%
FUSION FOR LOW BACK PAIN
Results not as good as for deformity or instability
Results not as good as for
discectomy surgery
WRONG diagnosis WRONG paHent
FUSION FOR LOW BACK PAIN
Results not as good as for deformity or instability
Results not as good as for
discectomy surgery
WRONG diagnosis WRONG paHent
FUSION FOR LOW BACK PAIN
DISEASE DIAGNOSIS symptoms and signs
Hx, Ex & Ix
TREATMENT CURE directed at pathology
The medical model
DISEASE DIAGNOSIS symptoms 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
Results not as good as for deformity or instability
Results not as good as for
discectomy surgery
WRONG diagnosis WRONG paHent
SUITABLE CANDIDATE • Self-‐employed • Successful business • No specific injury • No compensa5on or li5ga5on • Works with some difficulty • Has given up some of more acHve sports • Uses intermiCent over-‐the-‐counter analgesics • Non-‐smoker • Normal body weight • Goal is to be able to return to ac5ve lifestyle • No abnormal illness behaviour
UNSUITABLE CANDIDATE • Employee undertaking manual work • DissaHsfied with employment • UnremiYng pain aZer liZing at work • Unresolved WorkCover claim with civil ac5on pending
• Failed aCempts at return to work • Has given up all social acHviHes • Uses regular narco5c analgesia • Smoker • Unfit and overweight • Goal is for someone to get rid of their pain • Abnormal illness behaviour on examina5on
remove the disc
Interbody fusion
• 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
Transforaminal interbody
• allows nerve decompression
• allows all levels • familiarity
indications
• not suitable for ALIF • nerve compression esp foraminal compression
• correction of deformity
When is fusion good for LBP? • specific diagnosis
• clearly defined pain source
• suitable candidate • no negaHve psychosocial factors
• appropriate technique for pathology • some surgeon variaHon