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Low Back Pain: Current Surgical Approaches.

Baliga S, Treon K, Craig NJ - Asian Spine J (2015)

Bottom Line: Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures.Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods.We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.

View Article: PubMed Central - PubMed

Affiliation: Department of Elective Orthopaedics, Woodend Hospital, Aberdeen, UK.

ABSTRACT
Low back pain (LBP) is a worldwide phenomenon. The UK studies place LBP as the largest single cause of absence from work; up to 80% of the population will experience LBP at least once in their lifetime. Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures. However, around 10% of patients go on to develop chronic pain. This review outlines the basics of the traditional approach to spinal surgery for chronic LBP secondary to osteoarthritis of the lumbar spine as well as explains the novel concepts and terminology of back pain surgery. Traditionally, the stepwise approach to surgery starts with local anaesthetic and steroid injection followed by spinal fusion. Fusion aims to alleviate pain by preventing movement between affected spinal segments; this commonly involves open surgery, which requires large soft tissue dissection and there is a possibility of blood loss and prolonged recovery time. Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods. Newer MISS techniques include extreme lateral interbody fusion and axial interbody fusion. The main problem of fusion is the disruption of the biomechanics of the rest of the spine; leading to adjacent level disease. Theoretically, this can be prevented by performing motion-preserving surgeries such as total disc replacement, facet arthroplasty, and non fusion stabilisation. We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.

No MeSH data available.


Related in: MedlinePlus

Radiographs of an L5-S1 total disc replacement and a photograph of the prosthesis. Reprinted image of the Freedom Lumbar Disc with permission from AxioMed Spine Co., Cleveland, OH, USA.
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Figure 4: Radiographs of an L5-S1 total disc replacement and a photograph of the prosthesis. Reprinted image of the Freedom Lumbar Disc with permission from AxioMed Spine Co., Cleveland, OH, USA.

Mentions: Total disc replacement (TDR) is one such technique and it was developed to avoid the problems of adjacent level disease by preserving motion at the level. Pain relief is thought to be due to a combination of excision of the painful disc and restoration or improvement of load transfer [4445]. Prostheses are mainly used in the treatment of early disc degeneration, prior to facet joint degeneration. The prosthesis is implanted via an anterior retroperitoneal approach. After complete discectomy, the disc space is prepared and the implant is tapped into place (Fig. 4).


Low Back Pain: Current Surgical Approaches.

Baliga S, Treon K, Craig NJ - Asian Spine J (2015)

Radiographs of an L5-S1 total disc replacement and a photograph of the prosthesis. Reprinted image of the Freedom Lumbar Disc with permission from AxioMed Spine Co., Cleveland, OH, USA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522460&req=5

Figure 4: Radiographs of an L5-S1 total disc replacement and a photograph of the prosthesis. Reprinted image of the Freedom Lumbar Disc with permission from AxioMed Spine Co., Cleveland, OH, USA.
Mentions: Total disc replacement (TDR) is one such technique and it was developed to avoid the problems of adjacent level disease by preserving motion at the level. Pain relief is thought to be due to a combination of excision of the painful disc and restoration or improvement of load transfer [4445]. Prostheses are mainly used in the treatment of early disc degeneration, prior to facet joint degeneration. The prosthesis is implanted via an anterior retroperitoneal approach. After complete discectomy, the disc space is prepared and the implant is tapped into place (Fig. 4).

Bottom Line: Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures.Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods.We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.

View Article: PubMed Central - PubMed

Affiliation: Department of Elective Orthopaedics, Woodend Hospital, Aberdeen, UK.

ABSTRACT
Low back pain (LBP) is a worldwide phenomenon. The UK studies place LBP as the largest single cause of absence from work; up to 80% of the population will experience LBP at least once in their lifetime. Most individuals do not seek medical care and are not disabled by their pain once it is managed by nonoperative measures. However, around 10% of patients go on to develop chronic pain. This review outlines the basics of the traditional approach to spinal surgery for chronic LBP secondary to osteoarthritis of the lumbar spine as well as explains the novel concepts and terminology of back pain surgery. Traditionally, the stepwise approach to surgery starts with local anaesthetic and steroid injection followed by spinal fusion. Fusion aims to alleviate pain by preventing movement between affected spinal segments; this commonly involves open surgery, which requires large soft tissue dissection and there is a possibility of blood loss and prolonged recovery time. Established minimally invasive spine surgery techniques (MISS) aim to reduce all of these complications and they include laparoscopic anterior lumbar interbody fusion and MISS posterior instrumentation with pedicle screws and rods. Newer MISS techniques include extreme lateral interbody fusion and axial interbody fusion. The main problem of fusion is the disruption of the biomechanics of the rest of the spine; leading to adjacent level disease. Theoretically, this can be prevented by performing motion-preserving surgeries such as total disc replacement, facet arthroplasty, and non fusion stabilisation. We outline the basic concepts of the procedures mentioned above as well as explore some of the novel surgical therapies available for chronic LBP.

No MeSH data available.


Related in: MedlinePlus