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Procedures

Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Anterior Lumbar Interbody Fusion and Posterior Lumbar Interbody Fusion

 

The painful mechanical instability of the lumbar spine associated with spondylo-listhesis and degenerative disk disease is difficult to manage. Patients experience symptoms associated with compression of the nerve roots and cauda equina. Back pain is usually the primary complaint making it important to differentiate the pain from that caused by musculo-ligamentous strain. It is for this reason that we stress the importance of extensive conservative therapy before considering surgical intervention.

Plain x-ray flexion/extension films may demonstrate movement of one vertebral body over the other as well as reduced disk space height. A positive diskogram, where injection of radiopaque dye into the affected disk reproduces the patients pain and outlines a fissured or ruptured disk, localizes the level of involvement and is helpful in some cases. While compression may be caused in part by herniation of the disk, diskectomy alone is not effective in providing relief since additional impingement is produced by the reduction in disk space height and abnormal amount of additional movement allowed by the joint.

In Lumbar Interbody Fusion with cages the disk is removed and cages filled with bone are inserted between the vertebral bodies in order to maintain disk space height and fuse the joint, thereby eliminating abnormal movement. The cages can be inserted from an anterior approach (through the abdomen) or a posterior one (through the back). Your surgeon will determine the best approach.

Patients are kept in the hospital for 1-2 days after the procedure, and are usually able to return to work in 6-9 months. Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

The painful mechanical instability of the lumbar spine associated with spondylo-listhesis and degenerative disk disease is difficult to manage. Patients experience symptoms associated with compression of the nerve roots and cauda equina. Back pain is usually the primary complaint making it important to differentiate the pain from that caused by musculo-ligamentous strain. It is for this reason that we stress the importance of extensive conservative therapy before considering surgical intervention.

Plain x-ray flexion / extension films may demonstrate movement of one vertebral body over the other as well as reduced disk space height (figs.1&2). A positive diskogram, where injection of radiopaque dye into the affected disk reproduces the patients pain and outlines a fissured or ruptured disk, localizes the level of involvement and is helpful in some cases. While compression may be caused in part by herniation of the disk, diskectomy alone is not effective in providing relief since additional impingement is produced by the reduction in disk space height and abnormal amount of additional movement allowed by the joint.

In Lumbar Interbody Fusion with cages the disk is removed and titanium cages filled with bone are inserted between the vertebral bodies in order to maintain disk space height and fuse the joint, thereby eliminating abnormal movement (figs. 3-6). The cages can be inserted from an anterior approach (through the abdomen) or a posterior one (through the back). Your surgeon will determine the best approach.

Patients are kept in the hospital for 1-2 days after the procedure, and are usually able to return to work in 6-9 months.

Your doctor will provide details of the procedure that is right for you as well as the benefits and risks. He will also provide instructions for your care before and after the procedure.

The pain and instability of the lumbar spin caused by spondylolisthesis and degenerative disk disease can be difficult to manage. With 80% of the American population experiencing back pain at one point in their lives, procedures become commonplace. This is why the Buffalo Neurosurgery Group always recommends that patients consider conservative therapy before surgical procedures.

The degenerate disk is removed and titanium cages, filled with bone, are inserted between the vertebral bodies to maintain the appropriate disk space height and fuse the joint, which eliminates any abnormal movement. The cages can be inserted from an anterior approach (through the abdomen) or from a posterior approach (through the back). Your surgeon will determine the best approach for you.

Patients who undergo this procedure are usually kept in the hospital for 1-2 days after. Patients are also usually able to return to work and full activity in 6-9 months.

This description is a general overview. Your Buffalo Neurosurgery Group doctor will provide the details of the correct procedure for you. He will also explain the health benefits, risks and special pre and post-op care instructions.

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