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Surgery for degenerative conditions of the
lumbar spine
Dr Paul Licina – Spine Surgeon
STABILITY
RESTABILISATION
INSTABILITY
DESSICATION
OSTEOPHYTES
STABILITY
RESTABILISATION
INSTABILITY
DESSICATION
OSTEOPHYTES
DISC HERNIATION
LOW BACK PAIN
STABILITY
RESTABILISATION
INSTABILITY
DESSICATION
OSTEOPHYTES
STENOSIS
DEFORMITY
MISCONCEPTIONS
surgery is a last resort
weakness doesn’t improve
more trouble in the future
these get beDer by themselves
THE PERFECT INDICATION
HISTORY • pain for six weeks • leg pain > back pain • radicular pain
EXAMINATION • nerve compression signs • nerve tension signs
INVESTIGATIONS • MRI shows concordant herniation
• 35 y.o. male • 6 week history of severe sciaJca • numbness in S1 distribuJon
• unable to single heel raise on right • right calf wasJng • right SLR limited to 15°
INDICATIONS FOR EARLIER SURGERY
HISTORY • intolerable pain
EXAMINATION • functional weakness
INVESTIGATIONS • MRI shows huge herniation
• 33 y.o. female • 6 week history of severe sciaJca • bladder dysfuncJon and perineal
numbness for 2 days
• too painful for complete assessment • reduced bilateral SLR
INDICATIONS FOR STEROID INJECTION
HISTORY • moderate pain for less than six weeks • nonradicular pain
EXAMINATION • no positive supporting findings
INVESTIGATIONS • MRI shows small herniation
• 42 y.o. female • 4 week history of sciaJca • iniJally incapacitaJng, now improving
• no numbness, weakness or reflex loss • right SLR limited to 45°
SPINAL STENOSIS
narrowing of the spinal canal with nerve compression What is it ?
leg pain and neurogenic claudication
What does it cause ?
SPINAL STENOSIS
when symptoms severe When do we operate ?
SURGERY IN THE FORM OF DECOMPRESSION
nonoperative treatment unsuccessful
Why do we operate ?
SPINAL STENOSIS
stenosis with instability • degenerative spondylolisthesis • degenerative scoliosis
When do we add fusion ?
SPONDYLOLISTHESIS SCOLIOSIS
Aetiology • due to degeneration of
facet joint • facet joint stability fails
and L4 slips forward on L5 • leads to spinal stenosis
DEGENERATIVE SPONDYLOLISTHESIS
DEGENERATIVE SCOLIOSIS
Aetiology • due to asymmetric
degeneration of disc and facet joint
• vertebral tilt leads to spinal deformity and
accelerated degeneration • associated spinal stenosis
Thank you