Temporary external fixation for low back pain: Is it worth doing?

Abstract

Thirty-three patients with low back pain underwent spinal fusion following a positively predicting external fixation test. Thirty-two spinal fusions and one sacroiliac joint fusion were performed. The complications following the use of the external fixator were significant. The results following spinal fusion were not related to the positive response to the external fixator. Multiple variables affect the results of spinal fusion. We feel that the external fixator test in low back pain management is very invasive, and its use cannot be justified. K e y w o r d s Low back painExternal fixation

Temporary External Transpedicular Fixation of the Lumbosacral Spine

“…Other authors reported an infection rate of 2% up to 18%. 17,18,[22][23][24][25] Probably, complication rate increases with the duration of the test. 23 Since May 1997, flucloxacillin was administered orally in this trial as long as the external fixator was in situ.…”

“…The 8% nerve root irritation in the current study is in concordance with the 0% to 9% reported in other series of external skeletal fixations. 17,18,[22][23][24][25] In 2 patients, the external fixator had to be removed before completion of the test due to pain caused by root irritation. No permanent neurologic deficit was found.…”

Three-dimensional stabilization provided by the external spinal fixator compared to two internal fixation devices: a biomechanical in vitro flexibility study

“…On the other hand, in vitro studies have shown that under axial compressive loads the ESF still allows substantial axial translation [10,20], and does not reduce the loads acting on the disc [4]. Edwards et al concluded that the ESF relieves pain by reducing flexion and inhibiting the bulging of the disc [4], but other factors than purely mechanical ones have also been suggested [6,13].…”

“…Three-dimensional stabilization provided by the external spinal fixator compared to two internal fixation devices: a biomechanical in vitro flexibility study basis of this pain relief is still unknown, but additional mechanisms other than stabilization of the suspected painful segments have been suggested [6,13].…”

“…Olerud et al first suggested stabilization of the suspected symptomatic levels with the ESF in preoperative assessment of possible lumbar fusion candidates [12]. Since then, several clinical reports have stressed the value of the ESF test in evaluation of chronic low back pain (LBP) patients [3,5,16,18], while others have adopted a more cautious attitude [8], and yet others have considered its use as unjustifiable because of low predictive value and high potential for serious complications [2,6]. Undoubtedly, some chronic LBP patients do experience pain relief during the ESF test.…”