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Surgery for back pain
- 1. SURGERY FOR LOW BACK PAIN Paul Licina
- 2. Not all spine surgery is the same…
- 3. DISCECTOMY FOR DISCHERNIATION
- 5. DISCECTOMY FOR DISCHERNIATION Outcome • Day Surgery procedure • back to sedentary duHes in 3 weeks • back to sport in 6 weeks • good or excellent result in 90-‐95%
- 6. FUSION FOR LOWBACK PAIN
- 7. FUSION FOR LOWBACK PAIN What is fusion good for?
- 11. FUSION FOR LOWBACK PAIN What about low back pain?
- 12. FUSION FOR LOWBACK PAIN Results not as good as for deformity or instability Results not as good as for discectomy surgery WRONG diagnosis WRONG paHent
- 13. FUSION FOR LOWBACK PAIN Results not as good as for deformity or instability Results not as good as for discectomy surgery WRONG diagnosis WRONG paHent
- 14. FUSION FOR LOWBACK PAIN DISEASE DIAGNOSIS symptoms and signs Hx, Ex & Ix TREATMENTCURE directed at pathology The medical model
- 15. DISEASE DIAGNOSIS symptoms andsigns 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
- 16. CHRONIC SPECIFIC ACUTE SPECIFIC CHRONIC NON SPECIFIC ACUTE NONSPECIFIC
- 20. FUSION FOR LOWBACK PAIN Results not as good as for deformity or instability Results not as good as for discectomy surgery WRONG diagnosis WRONG paHent
- 21. 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
- 22. 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
- 23. Techniques FUSION FORLOW BACK PAIN
- 24. FUSION FOR LOWBACK PAIN Noninstrumented fusion
- 25. Instrumented fusion FUSION FOR LOWBACK PAIN
- 26. FUSION FOR LOWBACK PAIN Interbody fusion
- 27. remove the disc Interbody fusion • removethe pain source • stop the movement FUSION FOR LOW BACK PAIN
- 28. benefits Anterior interbody • anterior muscle-splitting only • minimal tissuetrauma indications • isolated degeneration • L5-S1 (L4-5) • no need to enter canal • thin, no previous major abdominal surgery FUSION FOR LOW BACK PAIN
- 31. benefits Transforaminal interbody • allows nerve decompression • allows alllevels • familiarity indications • not suitable for ALIF • nerve compression esp foraminal compression • correction of deformity
- 34.
- 42. 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
- 43.