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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

Radiograph showing interbody fusion after the extreme lateral interbody fusion procedure supplemented by posterior instrumentation, which can also be achieved by minimally invasive spine surgery; useful in correcting the spinal deformity.
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Figure 9: Radiograph showing interbody fusion after the extreme lateral interbody fusion procedure supplemented by posterior instrumentation, which can also be achieved by minimally invasive spine surgery; useful in correcting the spinal deformity.

Mentions: There are several limitations to the XLIF approach. Access to the L5-S1 disc is not possible and the L4-5 disc level can be obstructed by a high iliac crest or aberrant lumbar plexus anatomy. Similarly, access to the L1-2 level can sometimes be hindered by lower ribs. Trauma to the lumbar plexus is a potentially disastrous complication that can occur if adequate caution is not exercised while dissecting through the psoas muscle. However, intraoperative neural monitoring is designed to detect the lumbar plexus at a safe distance before significant retraction and insertion of surgical instruments (Fig. 9) [59].


Low Back Pain: Current Surgical Approaches.

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

Radiograph showing interbody fusion after the extreme lateral interbody fusion procedure supplemented by posterior instrumentation, which can also be achieved by minimally invasive spine surgery; useful in correcting the spinal deformity.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 9: Radiograph showing interbody fusion after the extreme lateral interbody fusion procedure supplemented by posterior instrumentation, which can also be achieved by minimally invasive spine surgery; useful in correcting the spinal deformity.
Mentions: There are several limitations to the XLIF approach. Access to the L5-S1 disc is not possible and the L4-5 disc level can be obstructed by a high iliac crest or aberrant lumbar plexus anatomy. Similarly, access to the L1-2 level can sometimes be hindered by lower ribs. Trauma to the lumbar plexus is a potentially disastrous complication that can occur if adequate caution is not exercised while dissecting through the psoas muscle. However, intraoperative neural monitoring is designed to detect the lumbar plexus at a safe distance before significant retraction and insertion of surgical instruments (Fig. 9) [59].

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