Artikel
Is Removal of Lumbar Instrumentation beneficial for the treatment of Recurrent Low Back Pain?
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Veröffentlicht: | 11. November 2003 |
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Gliederung
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Introduction
Removing spinal instrumentation in the absence of pseudarthrosis for the treatment of recurrent low back and leg pain is controversy discussed. This study compared two groups of patients who either had a solid or loose instrumentation for spinal fusion at the time of removal and the absence of pseudarthrosis and evaluated their outcome postoperatively, to determine if instrumentation removal is beneficial for patients with recurrent low back pain following lumbar fusion.
Patients and Methods
45 patients underwent an anterior and posterior lumbar spinal fusion. The removal of metalwork was performed by the same surgeon. The reason for the revision surgery was recurrent low back and leg pain. All patients had based on a thorough surgical exploration of the fusion mass a solid fusion. Instrumentation was deemed either solid or loose at time of removal based on the purchase at the screw-bone interface. Final outcomes were determined using a functional and satisfactory questionnaire and related to the two groups.
Results
The majority of the patients in both groups would recommend the surgery to a family member, would have the surgery again themselves and consider the surgery a success. The group of patients with loose instrumentation were significantly more likely to have a successful outcome than the group without loose instrumentation.
Conclusions
This study indicates that the removal of instrumentation in the absence of pseudarthrosis is beneficial in the relief of low back pain and leg pain symptoms. Increased success rates were noted in patients with loose instrumentation. However, this classification was based on inter-operative inspection. Further studies of the ability to diagnose and predict success prior to surgery needs to be done.