1 / 52

Back Pain

Back Pain. Christopher D. Sturm, M.D., F.A.C.S Medical Director Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center. Back Pain. Extremely common Often accompanied by leg pain or numbness Adversely affects quality of life Lost time, work & money

darren
Download Presentation

Back Pain

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Back Pain Christopher D. Sturm, M.D., F.A.C.S Medical Director Mercy Institute of Neuroscience & Mercy Regional Neurosurgery Center

  2. Back Pain • Extremely common • Often accompanied by leg pain or numbness • Adversely affects quality of life • Lost time, work & money • Can vary in intensity and duration, leading to significant frustration

  3. Back Pain But……THERE IS HOPE! You Do NOT have to just “live with it”

  4. Back Pain • Can lead to nerve damage • Permanent loss of some functions • Movement • Sensory • Bowel and Bladder control • In some instances earlier treatment can lead to better outcomes

  5. What to Do? • “So, what the heck is going on?” • “Can anything be done to fix it?” • “What are my options?” • “When should I start?” • “What are the success rates?”

  6. Causes of Back Pain • Muscle spasm/inflammation/strain • Degeneration or inflammation of the disc • Degeneration or inflammation of the back (facet) joints • Loss of normal alignment or instability • Fracture • Infection • Tumor

  7. Evaluation of Back Pain/Leg Pain • Symptom history and physical exam findings • What makes it worse or better? • Location? • Duration? • Associated pain/numbness/weakness? • Bowel and bladder control? • Past medical history?

  8. Evaluation of Back Pain/Leg Pain • MRI imaging • Optimal to evaluate discs, nerves, alignment • CT scan • Better visualization of the bone • Plain X-rays • Screening test • Bone Density study • Osteopenia/osteoporosis?

  9. “So, what to do?” • Depends on the cause of the pain • Is there any associated loss of function? • Are the symptoms significantly interfering with your quality of life? • Any indication they are getting better? • Have conservative therapies failed?

  10. Conservative Therapy • Symptom improvement without surgery • Activity modification • Pain medication • Physical therapy • Chiropractic intervention • Injectional therapy

  11. When is Surgery Appropriate? • If the symptoms are significantly interfering with your quality of life, and have not improved with conservative therapy measures, for an appropriate period of time • Any presence, or high risk of functional loss • Instability • Tumor • Infection

  12. Spinal Tumors - L1 Schwannoma

  13. Myxopapillary Ependymoma

  14. Advancements in Spine • Improved imaging techniques • Pathophysiology of degenerative disease • Biomechanical advancements • Image guidance • Minimally Invasive techniques • Mechanical implantation devices

  15. Mercy Regional Neurosurgery Multi-Center National Studies • CODA study • Posterior lumbar fusions • In-Fix study • Anterior lumbar fusions • Fortitude study • Cervical discectomy and fusions

  16. Lumbar Degenerative Disease • Initial desiccation of the disc • Loss of structural integrity of the disc • Loss of disc space height/potential HNP • Abnormal loading and laxity of the facet joints • Neuroforaminal compromise • Malalignment and abnormal motion

  17. Multi-level Lumbar Spondylosis

  18. Surgical Options • Lumbar discectomy • Lumbar laminectomy • Anterior lumbar interbody fusion (ALIF) • Posterior lumbar interbody fusion (PLIF) • Vertebroplasty/Kyphoplasty

  19. Lumbar Discectomy • Leg pain unresponsive to conservative therapy • Progressive deficit • Cauda equina syndrome • Small incision • Outpatient or next day discharge

  20. Right L5-S1 Discectomy

  21. Lumbar laminectomy • Leg pain secondary to lumbar stenosis/lateral recess stenosis • Failure of conservative therapy • Older patients, slightly larger incision, longer stay • Approximate 10% incidence of subsequent lumbar instability

  22. Lumbar laminectomy

  23. Anterior Lumbar Interbody Fusion (ALIF) • Lumbar degenerative disc disease producing mechanical LBP & minimal radicular pain • Localized concordant discogenic pain with discography at level(s) abnormal on MRI • Anterior approach avoids injury to posterior lumbar musculature • Suboptimal to address neural compression

  24. Provocative discography

  25. Anterior Lumbar Interbody Fusion

  26. L4-5 ALIF • 37 year old female with progressive mechanical LBP • Right leg psuedoradicular pain • Concordant L4-5 discogenic pain • Failed conservative therapy

  27. L4-5 In-Fix Cage

  28. 3 Level ALIF with InFix Cages

  29. Posterior Lumbar Interbody Fusion (PLIF) • Mechanical LBP with associated radicular pain and/or neurological deficit • Degenerative disc disease/collapse/herniation • Facet joint hypertrophy with foraminal stenosis • Lateral recess and/or central spinal stenosis • Spondylolysis/spondylolisthesis • Lumbar instability

  30. L4-5, L5-S1 PLIF • 50 year old female with progressive LBP and bilateral radicular pain w/dysesthesia • Intensifying pain despite previous L4-5 hemilaminectomy/discectomy • Lumbar MRI – L4-5, L5-S1 DDD & NFS • Concordant discogenic pain L4-5, L5-S1

  31. Pre operative MRI

  32. Cadence Cage

  33. PEEK Lordotic Lumbar Cages

  34. 3 Level PLIF w/PEEK Lordotic Cages

  35. L5-S1 PLIF • 49 year old female with progressive LBP and left leg radicular pain • Dysesthesia left leg/foot • MRI – L5-S1 DDD with left NFS • Failed conservative therapy • Concordant discogenic pain L5-S1

  36. Pre-operative MRI

  37. CODA Expandable Implant

  38. Pre- and Post-operative Lateral Views

  39. L5-S1 PLIF – CODA Cages

  40. Minimally Invasive Spine Surgery • Achieve same goals as “open” procedures • Smaller incisions • Less muscle trauma • Utilization of image guidance • Less post-operative pain • Shorter hospitalization

  41. 360 degree Lumbar revision – stand alone cages

  42. 360 degree Lumbar revision – titanium mesh

  43. 360 degree Lumbar revision – titanium mesh

  44. Results • Review of 5 years of practice data • Using the treatment approach outlined here • Improved or not? • Fusion? • Approximately 500 surgery patients • 93% reported improvement as a result of their surgery • 99% fusion rate

  45. Multi-level Cervical Spondylosis

  46. ACDF utilizing structural allografts

  47. Remodeling Cervical Allograft

  48. ACDF C4-5, C5-6 • 47 year old right handed female with posterior cervical pain and right arm radicular pain • Right deltoid and biceps weakness • Failed conservative therapy • Cervical spondylosis C4-5, C5-6

  49. Fortitude Ti Cages packed with Cerasorb, AcuFix Plate

  50. Fortitude Cages and AcuFix Plate

More Related