Low Back Pain: Current Surgical Approaches

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.

Unplanned Reoperation of Lumbar Spinal Surgery During the Primary Admission

“…A variety of diseases related to lumbar spine usually need surgical intervention when presenting with symptoms of low back pain and/or neurologic deficit failed to conservative treatment, such as lumbar disc herniation, lumbar spinal stenosis and spondylolisthesis [1,2] . The aims of surgical treatment are to decompress the nerve root, get the vertebra reduction and obtain a stable lumbar spine, which are helpful to relieve the low back pain and improve the quality of patients' life [3] .…”

Patient Care During Minimally Invasive Lateral Spine Surgery

“…In the United States, back pain is the most common cause of activity limitation in individuals less than 45 years of age and is the third most common cause of surgical procedures; further, it is estimated that 75% to 80% of adults will experience low back pain at least once in their lifetime . There are many pathological diseases of the spine for which a patient may seek medical attention, including…”

“… degenerative disc disease, traumatic spinal cord injuries, spondylolisthesis (ie, forward slippage of a vertebra), tumors of the spine, spinal column instability (eg, as a result of fracture), spinal deformity (eg, scoliosis), or stenosis of the spinal nerves (ie, narrowing of the space around the spinal cord leading to nerve root pressure) …”

“…Treatment options usually begin with conservative measures such as physical therapy, an exercise program, steroid injections, nerve stimulation, or acupuncture . However, if patients continue to have physical symptoms that limit their quality of life despite nonsurgical interventions, they may choose to be evaluated by a spine surgeon.…”

Assessment of the Possibilities of B-Mode Ultrasonography in the Diagnosis of Lumbar Intervertebral Discs Protrusion in Adolescents

“…The L5-S1 spine segment is a very common source of low back pain. Because of the forces acting on this segment, as well as the range of motion it provides, it is susceptible to injury or degeneration [1,2] . Common causes of pain include disc herniation, disc degeneration, facet joint arthritis, spondylolisthesis, spondylosis, spondylolysis and spinal stenosis.…”