Temporary External Transpedicular Fixation of the Lumbosacral Spine

Elmans, L.; Willems, Paul; Anderson, Peter; Limbeek, Jacques van; Kleuver, Marinus de; Schaaf, D. van der

doi:10.1097/01.brs.0000190868.57106.4d

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…four papers reported on discography, of which two studies focused on provocative discography of suspect levels (colhoun et al 1988), one study on provocation of the levels adjacent to the intended fusion (Willems et al 2007), and the fourth study focused on the amount of degeneration as registered at discography in a group of patients with a positive discographic pain response (gill and blumenthal 1992). three papers evaluated trial-immobilisation by external fixation, either with (Jeanneret et al 1994;elmans et al 2005) or without dynamisation (heini et al 2004).…”

Section: Postdiscography Discitis (Study V)mentioning

confidence: 99%

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

Willems¹

2013

Acta Orthopaedica

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Section: Postdiscography Discitis (Study V)mentioning

confidence: 99%

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

Willems¹

2013

Acta Orthopaedica

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“…A preoperative external pedicular fixation test leading to pain relief, supporting treatment by fusion, had been performed in all patients (Magerl 1984, Olerud et al 1986, Elmans et al 2005. Fusion was achieved by 3 techniques (Table).…”

Section: Surgerymentioning

confidence: 99%

Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery

2007

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Background and purpose Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment.Patients and methods The 9 patients, all of whom had been treated with a lumbar fusion after a preoperative intervertebral mobility assessment by spinal RSA, were re-examined 5 years after surgery. The intervertebral translations of the vertebra proximal to the fusion were determined by RSA and compared to the mobility of the same lumbar segment before fusion. The disc height and any progressive reduction at the two levels proximal to the one fused were measured on conventional radiographs.Results Adjacent segment mobility 5 years after fusion-expressed as mean transverse, vertical, and sagittal translation of the vertebra proximal to fusionwas not significantly changed compared to the mobility measured before surgery. Increased mobility of the segment seen in 5 individual patients was not associated with progressive degeneration of the same segment or to a poor clinical outcome.

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“…Its value in predicting the outcome of fusion for low back pain is debated,16 29 which was reflected in the completely contradictory surgeons' opinions. Trial immobilisation with a temporary external fixator is known for its high complication rate,30 and because of ambiguous results, its use is not recommended 31. In the present survey, external fixation was not frequently used (94% never used it) and only 13% of the surgeons believed in its predictive value.…”

Section: Discussionmentioning

confidence: 58%

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons

et al. 2011

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ObjectivesTo assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain.Design and settingNationwide survey among spine surgeons in the Netherlands.ParticipantsSurgeon members of the Dutch Spine Society were questioned on their surgical treatment strategy for chronic low back pain.Primary and secondary outcome measuresThe surgeons' opinion on the use of prognostic patient factors and predictive tests for patient selection were addressed on Likert scales, and the degree of uniformity was assessed. In addition, the influence of surgeon-specific factors, such as clinical experience and training, on decision making was determined.ResultsThe comments from 62 surgeons (70% response rate) were analysed. Forty-four surgeons (71%) had extensive clinical experience. There was a statistically significant lack of uniformity of opinion in seven of the 11 items on prognostic factors and eight of the 11 items on predictive tests, respectively. Imaging was valued much higher than predictive tests, psychological screening or patient preferences (all p<0.01). Apart from the use of discography and long multisegment fusions, differences in training or clinical experience did not appear to be of significant influence on treatment strategy.ConclusionsThe present survey showed a lack of consensus among spine surgeons on the appreciation and use of predictive tests. Prognostic patient factors were not consistently incorporated in their treatment strategy either. Clinical decision making for spinal fusion to treat chronic low back pain does not have a uniform evidence base in practice. Future research should focus on identifying subgroups of patients for whom spinal fusion is an effective treatment, as only a reliable prediction of surgical outcome, combined with the implementation of individual patient factors, may enable the instalment of consensus guidelines for surgical decision making in patients with chronic low back pain.

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Temporary External Transpedicular Fixation of the Lumbosacral Spine

Abstract: In this heterogeneous group of chronic patients with low back pain, TETF of the spine (including a placebo trial) does not appear to be of value in selecting suitable candidates for spinal fusion.

Cited by 12 publications

References 25 publications

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

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

Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons

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