J Korean Med Assoc.  2007 Jun;50(6):523-532. 10.5124/jkma.2007.50.6.523.

Surgical Management of Chronic Low Back Pain

• Jahng TA

• KMID: 2184861
• DOI: http://doi.org/10.5124/jkma.2007.50.6.523

Abstract

Conservative therapy remains the mainstay treatment of chronic low back pain (LBP). If this has failed, surgical options may be considered in carefully selected patients. Still surgical treatment for chronic LBP is a matter of intensive and controversial discussions. Nevertheless, surgical management for chronic (LBP) has been evolved and increased gradually. Spinal fusion has been the established surgical option in cases that did not respond to conservative therapy. Besides spinal fusion, newer technologies such as artificial disc replacement, dynamic stabilization, and spinal cord stimulation are being increasingly considered. Although successful results of these procedures have been published, evidence-based data on the efficacy and benefits of most of these techniques are still lacking. However, empirical data show good or at least satisfactory clinical results of these procedures when they were applied under restrictive indication criteria. Further prospective randomized controlled studies are mandatory to determine the role of these procedures, and basic research is necessary to understand the pathogenesis of LBP at the molecular and genetic levels

Keyword

Chronic low back pain; Surgical management; Spinal fusion; Artificial disc; Dynamic stabilization; Spinal cord stimulation

MeSH Terms

Humans
Low Back Pain*
Spinal Cord Stimulation
Spinal Fusion
Total Disc Replacement

Figure

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  Figure 1 Schemas of posterolateral fusion techniques.

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  Figure 2 Depiction of anterior lumbar interbody fusion (ALIF, left) and posterior interbody fusion (PLIF, middle), and postoperative lateral X-ray of PLIF (right).

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  Figure 3 PDN artificial nucleus (upper) and postoperative lateral X-ray after PDN nucleus replacement.

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  Figure 4 Charite artificial disc (upper) and postoperative AP and lateral X-ray after total disc replacement with Charite artificial disc (right A & B).

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  Figure 5 Dynesys stabilization system consist of pedicle screw and spacer, and polyethylene cord (left) and postoperative X-ray (middle and right).

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  Figure 6 NFlex dynamic stabilization system (left) and postoperative flexion/extension view shows maintenance of motion at L3-L4 (middle and right).

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  Figure 7 Spinal cord stimulation leads (left upper) and totally implantable pulse generators (left lower), and postoperative AP X-ray shows lead and generator (right).

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