1
|
Spine injections: the rationale for CT guidance. Skeletal Radiol 2023; 52:1853-1862. [PMID: 36149474 PMCID: PMC10449983 DOI: 10.1007/s00256-022-04188-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
Back pain is one of the most common medical problems and is associated with high socioeconomic costs. Imaging-guided spinal injections are a minimally invasive method to evaluate where the back pain is originating from, and to treat patients with radicular pain or spinal stenosis with infiltration of corticosteroids. CT-guided spine injections are a safe procedure, characterized by precise needle placement, excellent visualization of the relevant anatomical structures, and low radiation exposure for the patient and the interventional radiologist. In this review article, the variety of applications of CT-guided injections (focused on nerve roots and epidural injections) and the optimal injection procedure as well as risks and side effects are discussed.
Collapse
|
2
|
Next Level in Computed Tomography-Guided Periradicular Infiltration Therapy: Same Efficiency with Less Radiation Exposure. World Neurosurg 2023; 171:e24-e30. [PMID: 36334714 DOI: 10.1016/j.wneu.2022.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This retrospective cohort study investigated the radiation exposure and clinical efficiency of a new institutional low-dose protocol for computed tomography (CT)-guided lumbar periradicular infiltration (PRI). METHODS This was a retrospective matched-pair comparison of patients undergoing single-level lumbar PRI therapy employing a new low-dose CT protocol consisting of a helical scan with reduced energy levels and tube current versus the institutional standard CT protocol. The following variables were collected: dose-length product for the planning step, interventional step, and total examination, number of CT guidance scans, examination time, and postprocedural improvement on the numerical rating scale for radicular pain. RESULTS Forty-five patients were allocated to each group. A sufficient radiation dose reduction of 30% during PRI was achieved with the low-dose protocol with a median dose-length product of 9.8 mGy∗cm compared to 32.9 mGy∗cm with the standard protocol (P < 0.001). No need for additional multiple scans during the interventional mode was observed in the low-dose group, resulting in a comparable procedure time between the groups. Furthermore, the short-term pain-reducing effect of PRI was comparable between the low-dose and standard protocols (median delta numerical rating scale = 4 in both groups). CONCLUSIONS Our low-dose protocol with less tube voltage and lower electric current leads to less radiation exposure with the same safety and efficiency. In conclusion, every facility that performs CT-based procedures should check whether a further dose reduction is applicable to avoid stochastic radiation damage to the patient.
Collapse
|
3
|
Intradiscal oxygen-ozone therapy for the treatment of symptomatic lumbar disc herniation: A preliminary study. J Neuroradiol 2021; 49:180-186. [PMID: 34634298 DOI: 10.1016/j.neurad.2021.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess safety and effectiveness of computed tomography (CT)-guided intradiscal oxygen-ozone therapy (O2-O3 therapy) for the treatment of symptomatic lumbar disc herniation and radiological changes. MATERIALS AND METHODS This study was conducted in twenty patients presenting lumbar disc herniation with resistant lumbar or lumbar radicular pain They underwent intradiscal oxygen-ozone therapy under CT guidance. They were treated at one- or two-disc levels, representing a total of 24 discs treated. MR imaging examinations were obtained before treatment and 2 months post-procedure to analyse treatment-related disc modifications including modification of the surfaces of the disc and of the herniated disc, and the variations in disc height according to the disc height index. Clinical outcomes were assessed using the visual analogue scale (VAS) to evaluate the severity of pain before the procedure, at primary (2 months) and at secondary (12 months) follow-ups. RESULTS All the procedures were technically successful. The median VAS scores were 7.95 before the procedure, 3.9 at 2 months and 2.95 at 12 months. MRI analysis showed a significant decrease in herniation size at 2 months (-20%, p = 0.008). No immediate or late complications were observed. Only three patients (13.6%) underwent lumbar spine microdiscectomy in the year following ozone therapy. The treatment appeared to be more effective in cases of nerve root symptomatology. CONCLUSION This study suggests that intradiscal O2-O3 therapy is safe and effective for the treatment of lumbar disc herniation associated with resistant lumbar or lumbar radicular pain.
Collapse
|
4
|
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
Collapse
|
5
|
Abstract
Aims The aim of this study was to determine the efficacy of repeat epidural steroid injections as a form of treatment for patients with insufficiently controlled or recurrent radicular pain due to a lumbar or cervical disc herniation. Patients and Methods A cohort of 102 patients was prospectively followed, after an epidural steroid injection for radicular symptoms due to lumbar disc herniation, in 57 patients, and cervical disc herniation, in 45 patients. Those patients with persistent pain who requested a second injection were prospectively followed for one year. Radicular and local pain were assessed on a visual analogue scale (VAS), functional outcome with the Oswestry Disability Index (ODI) or the Neck Pain and Disability Index (NPAD), as well as health-related quality of life (HRQoL) using the 12-Item Short-Form Health Survey questionnaire (SF-12). Results A second injection was performed in 17 patients (29.8%) with lumbar herniation and seven (15.6%) with cervical herniation at a mean of 65.3 days (sd 46.5) and 47 days (sd 37.2), respectively, after the initial injection. All but one patient, who underwent lumbar microdiscectomy, responded satisfactorily with a mean VAS for leg pain of 8.8 mm (sd 10.3) and a mean VAS for arm pain of 6.3 mm (sd 9) one year after the second injection, respectively. Similarly, functional outcome and HRQoL were improved significantly from the baseline scores: mean ODI, 12.3 (sd 12.4; p < 0.001); mean NPAD, 19.3 (sd 24.3; p = 0.041); mean SF-12 physical component summary (PCS) in lumbar herniation, 46.8 (sd 7.7; p < 0.001); mean SF-12 PCS in cervical herniation, 43 (sd 6.8; p = 0.103). Conclusion Repeat steroid injections are a justifiable form of treatment in symptomatic patients with lumbar or cervical disc herniation whose symptoms are not satisfactorily relieved after the first injection. Cite this article: Bone Joint J 2018;100-B:1364–71.
Collapse
|
6
|
Periradicular infiltration of the lumbar spine: testing the robustness of an interventional ultra-low-dose protocol at different body mass index levels. Acta Radiol 2017; 58:1364-1370. [PMID: 28273743 DOI: 10.1177/0284185117694508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Computed tomography (CT)-guided periradicular infiltration remains a frequent interventional procedure for treatment of low back pain. Purpose To present an interventional ultra-low-dose protocol for CT-guided periradicular infiltration therapy and assess its application at different body mass index (BMI) levels. Material and Methods Over a period of 14 months, 79 patients underwent 183 CT-guided interventions for single-site lumbar periradicular therapy using an ultra-low-dose protocol with a basic setup of 100 kV and 5 mAs. Procedures were performed via intermittent fluoroscopy. A retrospective review was performed to analyze the parameters tube current and tube voltage, dose-length product, and BMI. Results The interventional ultra-low-dose protocol allowed safe treatment of 91.1% of the patients without a need for adapting the protocol. In seven patients with a higher BMI (range, 31-38 kg/m2; mean, 34 kg/m2), the tube current had to be increased to retain sufficient image quality. Only patients with a BMI of 30 and higher showed a significant correlation between BMI and dose-length product ( P value = 0.02), resulting in a slightly increased dose ( P value = 0.002). Conclusion The protocol presented for the interventional part of CT-guided periradicular infiltration allows to safely treat patients with a median calculated effective dose of 0.045 mSv (converted from a dose-length-product of 2.26 mGy*cm). Patients with a BMI of 30 and higher required a higher calculated effective dose with just one patient slightly exceeding 0.1 mSv.
Collapse
|
7
|
The Value of Short-Term Pain Relief in Predicting the One-Month Outcome of Lumbar Transforaminal Epidural Steroid Injections. World Neurosurg 2016; 96:323-333. [DOI: 10.1016/j.wneu.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
|
8
|
Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation. Korean J Radiol 2015; 16:874-80. [PMID: 26175588 PMCID: PMC4499553 DOI: 10.3348/kjr.2015.16.4.874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/12/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. MATERIALS AND METHODS A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) × 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined. RESULTS Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. CONCLUSION This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.
Collapse
|
9
|
CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25 Suppl 1:S177-82. [DOI: 10.1007/s00590-015-1602-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022]
|
10
|
Abstract
Needle insertions underlie a diversity of medical interventions. Steerable needles provide a means by which to enhance existing needle-based interventions and facilitate new ones. Tip-steerable needles follow a curved path and can be steered by twisting the needle base during insertion, but this twisting excites torsional dynamics that introduce a discrepancy between the base and tip twist angles. Here, we model the torsional dynamics of a flexible rod-such as a tip-steerable needle-during subsurface insertion and develop a new controller based on the model. The torsional model incorporates time-varying mode shapes to capture the changing boundary conditions inherent during insertion. Numerical simulations and physical experiments using two distinct setups-stereo camera feedback in semitransparent artificial tissue and feedback control with real-time X-ray imaging in optically opaque artificial tissue-demonstrate the need to account for torsional dynamics in control of the needle tip.
Collapse
|
11
|
A systematic review of the effectiveness of CT-guided, lumbar transforaminal injection of steroids. PAIN MEDICINE 2013; 14:1860-5. [PMID: 24330228 DOI: 10.1111/pme.12243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effectiveness and safety of computerized tomography (CT) guided, lumbar transforaminal injection of steroids in the treatment of radicular pain. DESIGN Systematic review of published literature. INTERVENTIONS Two reviewers independently assessed 19 publications on the effectiveness and safety of CT-guided, lumbar transforaminal injection of steroids. OUTCOME MEASURES For effectiveness, the primary outcome was the success rate for relief of pain. For safety, the radiation exposure involved and the nature of complications were determined. RESULTS Much of the literature fails to provide evidence. Two studies reported decreases in mean or median pain scores but no other data. Two studies reported success rates of between 34% and 62% for achieving 50% relief of pain at between 1 and 6 months after treatment. CT-guided injections may involve greater radiation exposure than does fluoroscopy-guided injections and do not avoid catastrophic spinal cord injury. CONCLUSION The evidence-base for CT-guided lumbar transforaminal injection of steroids is meagre. This intervention is not more effective than fluoroscopy-guided injections and is not demonstrably safer.
Collapse
|
12
|
Fluoroscopy-guided Periradicular Injections in Spine. Tech Orthop 2013. [DOI: 10.1097/bto.0b013e318286784a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register]
|
13
|
Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety. Patient Saf Surg 2012; 6:19. [PMID: 22888796 PMCID: PMC3482608 DOI: 10.1186/1754-9493-6-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/06/2012] [Indexed: 11/10/2022] Open
Abstract
Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011) at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30), coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2), the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31%) was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient safety of stochastic radiation effects.
Collapse
|
14
|
Effective Dose of CT-Guided Epidural and Periradicular Injections of the Lumbar Spine: A Retrospective Study. Open Orthop J 2012; 6:357-61. [PMID: 22942924 PMCID: PMC3431593 DOI: 10.2174/1874325001206010357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/17/2012] [Accepted: 07/22/2012] [Indexed: 11/24/2022] Open
Abstract
Spinal injection procedures can be performed blindly or, more accurately, with fluoroscopic or computed
tomography (CT) guidance. Radiographic guidance for selective nerve root blocks and epidural injections allows an
accurate needle placement, reduces the procedure time and is more secure for the patient, especially in patients with
marked degenerative changes and scoliosis, resulting in a narrowing of the interlaminar space. Limiting factors remain the
availability of scanners and the radiation dose. Interventional CT scan protocols in axial CT-acquisition mode for epidural
and periradicular injections help to limit the radiation dose without a significant decrease of image quality. The purpose of
this retrospective study was to analyze the effective radiation dosage patients are exposed during CT-guided epidural
lumbar and periradicular injections. A total amount of n=1870 datasets from 18 months were analyzed after multiplying
the dose length product with conversion factor k for each lumbar segment. For lumbar epidural injections (n=1286), a
mean effective dose of 1.34 mSv (CI 95%, 1.30-1.38), for periradicular injections (n=584) a mean effective dose of 1.38
mSv (CI 95%, 1.32-1.44) were calculated.
Collapse
|
15
|
|
16
|
Outcome of invasive treatment modalities on back pain and sciatica: an evidence-based review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15 Suppl 1:S82-92. [PMID: 16320030 PMCID: PMC3454546 DOI: 10.1007/s00586-005-1049-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 10/25/2005] [Indexed: 11/26/2022]
Abstract
Within the framework of evidence-based medicine high-quality randomised trials and systematic reviews are considered a necessary prerequisite for progress in orthopaedics. This paper summarises the currently available evidence on surgical and other invasive procedures for low back pain. Results of systematic reviews conducted within the framework of the Cochrane Back Review Group were used. Data were gathered from the latest Cochrane Database of Systematic Reviews 2005, Issue 2. The Cochrane reviews were updated using the evidence summary on surgery and other invasive procedures from the COST B13 European Guidelines for the Management of Acute and Chronic Non-Specific Low Back Pain. Facet joint, epidural, trigger point and sclerosant injections have not clearly been shown to be effective and can consequently not be recommended. There is no scientific evidence on the effectiveness of spinal stenosis surgery. Surgical discectomy may be considered for selected patients with sciatica due to lumbar disc prolapses that fail to resolve with the conservative management. Cognitive intervention Combined with exercises is recommended for chronic low back pain, and fusion surgery may be considered only in carefully selected patients after active rehabilitation programmes during 2 years time have failed. Demanding surgical fusion techniques are not better than the traditional posterolateral fusion without internal fixation.
Collapse
|
17
|
Transforaminal periradicular infiltration guided by CT for unilateral sciatica—an outcome study. Clin Imaging 2005; 29:211-4. [PMID: 15855068 DOI: 10.1016/j.clinimag.2004.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 07/26/2004] [Indexed: 11/18/2022]
Abstract
Selective transforaminal periradicular infiltration with local corticosteroids and anesthetics has been performed for preoperative evaluation of lumbosacral pain and for patients with sciatia. From July 2001 to November 2003, 143 patients with unilateral sciatica were treated with computed tomography (CT)-guided transforaminal periradicular infiltration. Needle puncture was possible without difficulty in all patients. Of all 143 infiltrations, 140 were followed up with the recovery of leg and back pain and improvement of the straight leg-raising test (SLRT). Minor complications were seen, but major complications and mortality did not occur in our series. In summary, CT guidance allows safe and precise needle positioning, and it can readily demonstrate the spread of the medications in the exact periradicular space.
Collapse
|
18
|
|
19
|
Abstract
Pain originating from the spine is a common clinical problem that is often difficult to manage. This chapter considers the evidence supporting the use of corticosteroid injections for pain of spinal origin. Clinical problems considered in this review are radicular pain, zygapophyseal joint pain, discogenic pain and non-specific pain from the cervical, lumbar and thoracic spine. Issues of efficacy and adverse events are considered. No useful data were found concerning the treatment of any type of thoracic pain with corticosteroid injections. In the lumbar spine, there is evidence to support the use of transforaminal injections for radicular pain. Intradiscal and intra-articular injections in both lumbar and cervical spines have not been shown to be effective. Sacroiliitis responds well to intra-articular corticosteroids. There is insufficient evidence to support the use of atlanto-axial or atlanto-occipital joint injections.
Collapse
|
20
|
Intraspinal Steroids: History, Efficacy, Accidentality, and Controversy With Review of United States Food and Drug Administration Reports. ACTA ACUST UNITED AC 2001. [DOI: 10.1097/00013414-200112000-00004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
21
|
Intraspinal steroids: history, efficacy, accidentality, and controversy with review of United States Food and Drug Administration reports. J Neurol Neurosurg Psychiatry 2001; 70:433-43. [PMID: 11254764 PMCID: PMC1737322 DOI: 10.1136/jnnp.70.4.433] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
Late postoperative results in 1000 work related lumbar spine conditions. SURGICAL NEUROLOGY 2000; 54:101-6; discussion 106-8. [PMID: 11077091 DOI: 10.1016/s0090-3019(00)00283-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Poor results after lumbar spinal surgery have been recorded in compensation cases throughout the world medical literature. It seems that psychosocial factors play an important role in the delay in returning to gainful employment but that chronic postoperative lumbar and lower extremity pain is blamed for this state of affairs. The present series of late outcomes is based on actual physical examination by independent neurosurgical and orthopedic experts appointed by the Workman's Compensation Board, providing an impartial opinion as to the discrepancy between objective findings and failure to reintegrate into the work force. METHODS One thousand workmen's compensation patients who had undergone lumbar spinal surgery were divided into two groups, one of 600 patients with single operations, evaluated on average 51 months after surgery, and the second of 400 with multiple operations, evaluated on average 38 months postoperatively. RESULTS Seventy-one percent of the single operation group had not returned to work more than 4 years after the operation, and 95% of the multiple operations group. In none of these cases was there a neurological deficit that precluded gainful employment, the failure to return to work being blamed on chronic postoperative pain. CONCLUSIONS Although motivational (that is, psychosocial) factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. Increased attention must be devoted to ascertaining the etiology of this pain and ways to prevent it.
Collapse
|