Surgery for Low Back Pain.pdf

Surgery for Low Back Pain

Marek Szpalski

Robert Gunzburg

Björn L. Rydevik

Jean-Charles Le Huec

H. Michael Mayer (Eds.)

Surgery for

Low Back Pain

Marek Szpalski, MD

Department of Orthopedic Surgery

Hôpitaux Iris Sud

Université Libre de Bruxelles

142 rue Marconi

1190 Brussels, Belgium

Department of Orthopedics

New York University

New York, USA

mszp@skynet.be

Björn L. Rydevik, MD, PhD

Sahlgrenska University Hospital/Sahlgrenska

Department Orthopaedic Surgery

413 45 Göteborg

Sweden

bjorn.rydevik@orthop.gu.se

Jean-Charles Le Huec, MD

CHU Bordeaux Hôpital Pellegrin

Service d’Orthopédie Traumatologie

Place Amalie Raba Leon

33076 Bordeaux CX

France

j-c.lehuec@chu-bordeaux.fr

Robert Gunzburg, MD

Eeuwfeestkliniek

Algemeen Ziekenhuis Monica

Harmoniestraat 68

2018 Antwerpen

Belgium

robert@gunzburg.be

H. Michael Mayer, MD, PhD

Orthopädische Klinik

München-Harlaching

Wirbelsäulenzentrum

Harlachinger Str. 51

81243 München

Germany

mmayer@schoen-kliniken.de

ISBN: 978-3-642-04546-2 e-ISBN: 978-3-642-04547-9

DOI: 10.1007/978-3-642-04547-9

Springer Heidelberg Dordrecht London New York

Library of Congress Control Number: 2009938032

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Preface

Low back pain is one of the most common conditions encountered in clinical prac-

tice; however, its deinition itself is subject to debate and precise knowledge about it

is conlicting. It can be attributed to a great number of different origins although,

often, the true cause of nociception cannot be precisely deined. Furthermore, psy-

chosocial variables have an important inluence on the reporting back pain symp-

toms. Nevertheless, low back pain and the pathologies believed to be its cause are the

main indication for spine surgery in most area of the world while true evidence about

indications remains elusive and there is much discussion about the very different

techniques used.

The goal of this book is to shed some light on this complex subject. The indispens-

able bases of biology and biomechanics of spinal structures are covered as well as the

important psychosocial determinants associated with back complaints. Diagnosis is

now enhanced by new magnetic resonance techniques described thoroughly.

Conservative treatment is still the base of low back pain handling, and natural his-

tory of the condition as well as the main conservative therapeutic options are described

in detail. Medications, rehabilitation, back schools, manipulative therapies, and

orthoses are the subject of fully documented chapters.

Surgical techniques abound for the treatment of lumbar spine disorders and this

book tries to clarify their indications and results. For many years fusion was the most

used technique and became the “de facto” gold standard. The role of pelvic girdle

pain and facet syndrome is subject to debate and the possible surgical treatment is

discussed in those conditions. Chapters will cover different technique as well as the

possible drawbacks like blood loss and adjacent level degeneration. The latter has led

to the development of “nonfusion” technologies like artiicial disks, semirigid ixa-

tion techniques, or interspinous implants. Indications, counter indications, techniques,

and complications of those different techniques are presented and lead to discussion

about what evidence we have for their effectiveness.

Outcome assessment is paramount to inding evidence for treatments of low back

pain. The principles of outcome assessment in back pain as well as the review of

actual available evidence ends the book.

This book is intended for clinicians as well as researchers in many ields of spinal

disorders. It is of use to orthopedic and neurosurgeons, rheumatologists, neurologists,

physiatrists, physical therapists, as well as psychologists and social security and

insurance specialists.

Brussels, Belgium

Marek Szpalski

Antwerp, Belgium

Robert Gunzburg

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