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Surgery for Low Back Pain

Marek SzpalskiRobert GunzburgBjörn L. RydevikJean-Charles Le HuecH. Michael Mayer (Eds.)Surgery forLow Back Pain

Marek Szpalski, MDDepartment of Orthopedic SurgeryHôpitaux Iris SudUniversité Libre de Bruxelles142 rue Marconi1190 Brussels, BelgiumDepartment of OrthopedicsNew York UniversityNew York, USAmszp@skynet.beRobert Gunzburg, MDEeuwfeestkliniekAlgemeen Ziekenhuis MonicaHarmoniestraat 682018 AntwerpenBelgiumrobert@gunzburg.beBjörn L. Rydevik, MD, PhDSahlgrenska University Hospital/SahlgrenskaDepartment Orthopaedic Surgery413 45 les Le Huec, MDCHU Bordeaux Hôpital PellegrinService d’Orthopédie TraumatologiePlace Amalie Raba Leon33076 Bordeaux CXFrancej-c.lehuec@chu-bordeaux.frH. Michael Mayer, MD, PhDOrthopädische chinger Str. 5181243 MünchenGermanymmayer@schoen-kliniken.deISBN: 978-3-642-04546-2     e-ISBN: 978-3-642-04547-9DOI: 10.1007/978-3-642-04547-9Springer Heidelberg Dordrecht London New YorkLibrary of Congress Control Number: 2009938032 Springer-Verlag Berlin Heidelberg 2010This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting,reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publicationor parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965,in its current version, and permission for use must always be obtained from Springer. Violations are liableto prosecution under the German Copyright Law.The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply,even in the absence of a specific statement, that such names are exempt from the relevant protective lawsand regulations and therefore free for general use.Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consultingthe relevant literature.Cover design: eStudio Calamar, Figueres/BerlinPrinted on acid-free paperSpringer is part of Springer Science Business Media (www.springer.com)

PrefaceLow back pain is one of the most common conditions encountered in clinical practice; however, its definition itself is subject to debate and precise knowledge about itis conflicting. It can be attributed to a great number of different origins although,often, the true cause of nociception cannot be precisely defined. Furthermore, psychosocial variables have an important influence on the reporting back pain symptoms. Nevertheless, low back pain and the pathologies believed to be its cause are themain indication for spine surgery in most area of the world while true evidence aboutindications remains elusive and there is much discussion about the very differenttechniques used.The goal of this book is to shed some light on this complex subject. The indispensable bases of biology and biomechanics of spinal structures are covered as well as theimportant psychosocial determinants associated with back complaints. Diagnosis isnow enhanced by new magnetic resonance techniques described thoroughly.Conservative treatment is still the base of low back pain handling, and natural history of the condition as well as the main conservative therapeutic options are describedin detail. Medications, rehabilitation, back schools, manipulative therapies, andorthoses are the subject of fully documented chapters.Surgical techniques abound for the treatment of lumbar spine disorders and thisbook tries to clarify their indications and results. For many years fusion was the mostused technique and became the “de facto” gold standard. The role of pelvic girdlepain and facet syndrome is subject to debate and the possible surgical treatment isdiscussed in those conditions. Chapters will cover different technique as well as thepossible drawbacks like blood loss and adjacent level degeneration. The latter has ledto the development of “nonfusion” technologies like artificial disks, semirigid fixation techniques, or interspinous implants. Indications, counter indications, techniques,and complications of those different techniques are presented and lead to discussionabout what evidence we have for their effectiveness.Outcome assessment is paramount to finding evidence for treatments of low backpain. The principles of outcome assessment in back pain as well as the review ofactual available evidence ends the book.This book is intended for clinicians as well as researchers in many fields of spinaldisorders. It is of use to orthopedic and neurosurgeons, rheumatologists, neurologists,physiatrists, physical therapists, as well as psychologists and social security andinsurance specialists.Brussels, Belgium Antwerp, Belgium Marek SzpalskiRobert Gunzburgv

ContentsPart IBasics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11.1The Biology of Intervertebral Disc Degeneration . . . . . . . . . . . . . . . .Cornelia Neidlinger-Wilke and Hans-Joachim Wilke31.2Low Back Pain: Where Does the Pain Come From? . . . . . . . . . . . . . .Helena Brisby111.3The Role of Cytokines in the Degenerative Spine . . . . . . . . . . . . . . . .Björn Rydevik and Helena Brisby171.4Psychosocial Aspects of Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . .Christine Cedraschi and Valérie Piguet231.5Instability and Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tommy Hansson29Part IIDiagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .372.1Dynamic MRI of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .J. J. Abitbol, Soon-Woo Hong, Sana Khan, and Jeffrey C. Wang392.2Assessment of Status of End Plate and Diffusionin Degenerative Disc Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S. Rajasekaran2.3The Role of Physician Extenders in a Low Back Pain Practice . . . . .Michael R. Zindrick, Michael N. Tzermiadianos, Cary R. Templin,and Raymond E. Hines IIIPart III4757Conservative Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .633.1Natural Evolution of Nonspecific Low-Back Pain . . . . . . . . . . . . . . . .Michel Benoist and Thibaut Lenoir653.2Prescribing Conservative Treatment for Low Back Pain . . . . . . . . . .F. Balagué and J. Dudler73vii

viii3.33.43.53.6ContentsComprehensive Rehabilitation for Low back Painand Back Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Margareta Nordin79The Place of Chiropractic Care in the Treatmentof Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Christopher J. Colloca85Efficacy of IDET and PIRFT for the Treatmentof Discogenic Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Brian J. C. Freeman95Lumbar Orthoses to Prevent and Treat Low-Back Pain . . . . . . . . . . .Michel Benoist and Thibaut LenoirPart IV101Surgical Treatment: Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1074.1Indication for Lumbar Spinal Fusion . . . . . . . . . . . . . . . . . . . . . . . . . .Max Aebi1094.2Evidence for Efficacy of Pedicle-Based Systems . . . . . . . . . . . . . . . . .Jeremy Fairbank1234.3Low Back Pain Is Not an Indication for Stabilisationin Patients Operated for Lumbar Spinal Stenosis . . . . . . . . . . . . . . . .E. Munting127Hybrid Construct for DDD in the Lumbar Spine:The Compromise Between Fusion and Nonfusion . . . . . . . . . . . . . . . .J. C. Le. Huec, R. Meyrat, F. Debusscher and S. Aunoble1314.44.5The Management of Spondylolysis and Spondylolisthesis . . . . . . . . .Brian J. C. Freeman and Ujjwal K. ral (TPDC)-Fixation . . . . . .Max Aebi1474.7Facet Problems: A Surgical Indication? . . . . . . . . . . . . . . . . . . . . . . . .F. Pellisé1554.8Adjacent Level Disease: “Myth” or “Fact” . . . . . . . . . . . . . . . . . . . . .David A. Wong and Katherine E. Wong1594.9Pelvic Girdle Pain: Indication for Surgery? . . . . . . . . . . . . . . . . . . . . .Bengt Sturesson1654.10 Blood Loss Management in Major Spine Surgery . . . . . . . . . . . . . . . .Serena S. Hu and Jeremy A. Lieberman169

ContentsixPart V5.15.25.3Surgical Treatment: Other Technologies . . . . . . . . . . . . . . . . . . . . .How Disc Replacement Fits in the TreatmentAlgorithm for Degenerative Disc Disease:Refining Indications for Disc Replacement . . . . . . . . . . . . . . . . . . . . .Richard D. Guyer and Donna D. OhnmeissClinical Factors that May Affect Outcomein Lumbar Total Disc Replacement. What Is the Evidence? . . . . . . .Michael R. Zindrick, Mark Lorenz, Leonard I. Voronov,Michael N. Tzermiadianos, and Alexander HadjipavlouA Prospective Randomized Comparisonof Two Lumbar Total Disk Replacements . . . . . . . . . . . . . . . . . . . . . .Richard D. Guyer and Donna D. Ohnmeiss1751771831935.4Limitations of Lumbar Disk Arthroplasty . . . . . . . . . . . . . . . . . . . . . .Serena S. Hu5.5Is Posterior Dynamic Stabilization an Optionto Avoid Adjacent Segment Decompensation? . . . . . . . . . . . . . . . . . . .Missoum Moumene and Jürgen Harms207Immediate Biomechanical Effectsof Lumbar Posterior Dynamic Stabilisation . . . . . . . . . . . . . . . . . . . . .Brian J. C. Freeman and Caspar E. W. Aylott213Overview of Pedicle Screw-Based PosteriorDynamic Stabilization Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Richard D. Guyer, Donna D. Ohnmeiss, and Kevin R. Strauss2215.65.75.8Semirigid Fixation System for the Lumbar Spine . . . . . . . . . . . . . . . .Dieter Grob, Andrea Luca, and Anne F. Mannion5.9Nonrigid Stabilization of the Spine – Problems Observed:Screw Loosening/Breakage/Implant Failure/AdjacentSegment Degeneration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Paul F. Heini5.10 Interspinous Implants: State of the Artand Research of Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Marek Szpalski, Robert Gunzburg, Christopher J. Colloca,and Robert J. Moore5.11 NuBac Disc Arthroplasty System:Rationale and Clinical Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Massimo Balsano, Domagoj Coric, and Margreet Derks199227233241249

xContentsPart VIOutcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .257Outcome Assessment for Cost-Utility Evaluations:SF-6D vs. EQ-5D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Rikke Søgaard, Terkel Christiansen, and Finn Bjarke Christensen259Review of the Medical Evidence Regardingthe Surgical Treatment of Low Back Pain . . . . . . . . . . . . . . . . . . . . . .Andrew P. White, Justin G. Brothers, and Alexander R. Vaccaro267Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2796.16.2