Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

Willems, Paul

doi:10.3109/17453674.2012.753565

Cited by 69 publications

(55 citation statements)

References 135 publications

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“…Discography, as previously demonstrated in a number of studies, is an unreliable method without gold standard and without any yet proven clinical utility in terms of improved surgery success [41]. Both human and animal in vivo studies have shown that even disc puncture with small-gauge needles induces disc degeneration, while discography must be contested in general and in particular regarding injection of a control disc [42,43].…”

Section: Discussionmentioning

confidence: 95%

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

2014

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Section: Discussionmentioning

confidence: 95%

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

2014

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“…41 Identifying which patients are likely to benefit from fusion surgery is difficult: a systematic review found that immobilization, provocative discography, and temporary external fixation were not useful in predicting which patients would benefit from fusion surgery. 42 Given the difficulties in determining who will benefit from surgery, the American College of Physicians recently updated their LBP treatment guidelines, recommending noninvasive, nonpharmacologic treatments as the first line of therapy. 43 However, nonsurgical treatments also have mixed results.…”

Section: Low Back Pain In the Clinicmentioning

confidence: 99%

Looking beyond the intervertebral disc: the need for behavioral assays in models of discogenic pain

Mosley

Evashwick‐Rogler

Lai

et al. 2017

Annals of the New York Academy of Sciences

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Orthopedic research into chronic discogenic back pain has commonly focused on aging- and degeneration-related changes in intervertebral disc structure, biomechanics, and biology. However, the primary spine-related reason for physician office visits is pain. The ambiguous nature of the human condition of discogenic low back pain motivates the use of animal models to better understand the pathophysiology. Discogenic back pain models must consider both emergent behavioral changes following pain induction and changes in the nervous system that mediate such behavior. Looking beyond the intervertebral disc, this review describes the different ways to classify pain in human patients and in animal models. We describe several behavioral assays that can be used in rodent models to augment disc degeneration measurements and characterize different types of pain. We review rodent models of discogenic pain that employed behavioral pain assays and highlight a need to better integrate neuroscience and orthopedic science methods to extend current understanding of the complex and multifactorial pathophysiology of discogenic back pain.

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“…In those cases with significant disc space, and instability on dynamic views (>5 mm displacement or >10°-15° rotation on lateral standing flexion-extension lumbosacral radiographs) in especially those cases with slip greater than 25%, accompanying fusion is also necessary [24,25]. When the chief complaint of the patient is a refractory low back pain and no significant stenosis is apparent on imaging studies, fusion is recommended (without any accompanying decompression) [26]. …”

Section: Preoperative Indicatorsmentioning

confidence: 99%

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

2014

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Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.

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Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

Cited by 69 publications

References 135 publications

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

Comparison between pain at discography and morphological disc changes at axial loaded MRI in patients with low back pain

Looking beyond the intervertebral disc: the need for behavioral assays in models of discogenic pain

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

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