Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: Pedicle screw fixation as an adjunct to posterolateral fusion

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

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Full Percutaneous Lumbar Interbody Fusion: Technical Note

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1604360 ◽

2017 ◽

Vol 78 (06) ◽

pp. 601-606 ◽

Cited By ~ 3

Author(s):

Mitsuto Taguchi ◽

Shu Nakamura

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pedicle Screw ◽

Interbody Fusion ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Low Back ◽

Lumbar Interbody Fusion ◽

Less Invasive ◽

Disk Degeneration

Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.

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Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain

Journal of Neurosurgery Spine ◽

10.3171/spi.2005.2.6.0700 ◽

2005 ◽

Vol 2 (6) ◽

pp. 700-706 ◽

Cited By ~ 26

Author(s):

Daniel K. Resnick ◽

Tanvir F. Choudhri ◽

Andrew T. Dailey ◽

Michael W. Groff ◽

Larry Khoo ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Degenerative Disease ◽

Posterolateral Fusion ◽

Low Back

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Predictive factors for successful clinical outcome 1 year after an intensive combined physical and psychological programme for chronic low back pain. Miranda L. van Hooff, Maarten Spruit, John K. O'Dowd, Wim van Lankveld, Jeremy C. T. Fairbank, Jacques van Limbeek. Eur Spine J. 2014 Jan;23(1):102-12. doi: 10.1007/s00586-013-2844-z. Epub 2013 Jun 16

The Spine Journal ◽

10.1016/j.spinee.2014.03.018 ◽

2014 ◽

Vol 14 (6) ◽

pp. 1058

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Outcome ◽

Predictive Factors ◽

Chronic Low Back Pain ◽

Low Back ◽

Successful Clinical Outcome

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: Lumbar fusion for disc herniation and radiculopathy

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14271 ◽

2014 ◽

Vol 21 (1) ◽

pp. 48-53 ◽

Cited By ~ 34

Author(s):

Jeffrey C. Wang ◽

Andrew T. Dailey ◽

Praveen V. Mummaneni ◽

Zoher Ghogawala ◽

Daniel K. Resnick ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Lumbar Fusion ◽

Signs And Symptoms ◽

Herniated Disc ◽

Spinal Instability ◽

Low Back ◽

Low Level ◽

Disc Herniations

Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.

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A Prospective Randomized Controlled Study of Auricular Point Acupressure to Manage Chronic Low Back Pain in Older Adults: Study Protocol

10.21203/rs.2.15609/v2 ◽

2019 ◽

Author(s):

Chao Hsing Yeh ◽

Cuicui Li ◽

Ronald Glick ◽

Elizabeth A. Schlenk ◽

Kathryn Albers ◽

...

Keyword(s):

Older Adults ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Comparison Group ◽

Controlled Study ◽

Low Back ◽

Randomized Controlled ◽

Auricular Point

Abstract Background: Chronic low back pain (cLBP) is a major health problem and the most common pain condition among those 60 years of age or older in the US. Despite the development of pharmacological and nonpharmacological interventions, cLBP outcomes have not improved and disability rates continue to rise. This study aims to test auricular point acupressure (APA) as a non-invasive, nonpharmacological self-management strategy to manage cLBP and to address current shortcomings of cLBP treatment. Methods: For this prospective randomized controlled study, participants will be randomly assigned into three groups: (1) APA (active points related to cLBP), (2) Comparison Group -1 (non-active points, unrelated to cLBP), (3) Comparison Group-2 (enhanced educational control, an educational booklet on cLBP will be given and the treatment used by participants for their cLBP will be recorded). The ecological momentary assessment smartphone app will be used to collect real-time cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo effects will be measured via questionnaires for all participants. This proposed trial will evaluate the APA sustained effects for cLBP at 12-month follow-up. Monthly phone follow-up will be used to collect study outcomes. Blood will be collected during study visits at baseline, post-APA treatment, and follow-up study visits at 1-, 3-, 6-, 9- and 12-months post-completion of treatment for a total of 7 assessments. Appointments will start between 9 and 11 am to control for circadian variation in cytokine levels. Discussion: This study is expected to provide vital information on the efficacy, sustainability, and underlying mechanism of APA on cLBP necessary for APA to gain acceptance from both healthcare providers and patients, which would provide a strong impetus for including APA as part of cLBP management in clinical and home settings. Trial registration: NCT03589703, Registered on May 22, 2018 Keywords: Chronic low back pain, auricular point acupressure, older adults, cytokines

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Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery

Pain medicine ◽

10.31636/pmjua.v5i4.2 ◽

2021 ◽

Vol 5 (4) ◽

pp. 8-15

Author(s):

Mei-ping Qian ◽

Mei-rong Dong ◽

Fang Kang ◽

Juan Li

Keyword(s):

Chronic Pain ◽

Low Back Pain ◽

Back Pain ◽

Hospital Stay ◽

Chronic Low Back Pain ◽

Pain Sensitivity ◽

Lumbar Fusion ◽

Low Back ◽

Fusion Surgery ◽

Lumbar Fusion Surgery

Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery. Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded. Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05). Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.

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A Prospective Randomized Controlled Study of Auricular Point Acupressure to Manage Chronic Low Back Pain in Older Adults: Study Protocol

10.21203/rs.2.15609/v1 ◽

2019 ◽

Author(s):

Chao Hsing Yeh ◽

Cuicui Li ◽

Ronald Glick ◽

Elizabeth A. Schlenk ◽

Kathryn Albers ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Comparison Group ◽

Randomized Controlled Study ◽

Controlled Study ◽

Low Back ◽

Randomized Controlled ◽

Auricular Point

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11:2287. A double blind placebo controlled study evaluating the effect of a metalloproteinase inhibitor in chronic low back pain secondary to degenerative disc disease

The Spine Journal ◽

10.1016/j.spinee.2005.05.089 ◽

2005 ◽

Vol 5 (4) ◽

pp. S46

Author(s):

Anthony Guarino ◽

Martha Cornell

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Degenerative Disc Disease ◽

Controlled Study ◽

Low Back ◽

Disc Disease ◽

Double Blind ◽

Double Blind Placebo ◽

Metalloproteinase Inhibitor

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Efficacy and safety of fasinumab in patients with chronic low back pain: a phase II/III randomised clinical trial

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217259 ◽

2020 ◽

pp. annrheumdis-2020-217259

Author(s):

Paula Dakin ◽

Alan J Kivitz ◽

Joseph S Gimbel ◽

Nebojsa Skrepnik ◽

Stephen J DiMartino ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Phase Ii ◽

Chronic Low Back Pain ◽

Randomised Clinical Trial ◽

Controlled Study ◽

Low Back ◽

Efficacy And Safety ◽

Double Blind ◽

And Function

ObjectivesTo study the efficacy and safety of fasinumab in moderate-to-severe, chronic low back pain (CLBP).MethodsIn this phase II/III, double-blind, placebo-controlled study, patients with CLBP aged ≥35 years with inadequate pain relief/intolerance to acetaminophen, non-steroidal anti-inflammatory drugs and opioids were randomised to fasinumab 6 or 9 mg subcutaneous every 4 weeks (Q4W), 9 mg intravenous every 8 weeks (Q8W) or placebo. Primary endpoint was change from baseline to week 16 in average daily low back pain intensity (LBPI) numeric rating score. Key secondary efficacy variables included Roland-Morris Disability Questionnaire (RMDQ) and Patient Global Assessment (PGA). The results are based on a modified intent-to-treat analysis of 563/800 planned patients when enrolment was stopped early given emerging signals of joint risk in other osteoarthritis (OA) studies at doses being tested here.ResultsSignificant placebo-adjusted LBPI reductions at week 16 were observed for fasinumab 9 mg Q4W and Q8W (least squares mean (standard error) −0.7 (0.3); both nominal p<0.05), but not 6 mg (–0.3 (0.3); p=0.39). RMDQ and PGA improvements to week 16 were greatest for fasinumab 9 mg intravenous. Numerically greater efficacy occurred in patients with, versus those without, peripheral OA (pOA) over 16 weeks. Treatment-emergent adverse events (AEs) occurred in 274/418 (65.6%) patients in the combined fasinumab groups and 94/140 (67.1%) placebo patients. Joint AEs, mostly rapid progressive OA type 1, were more frequent in the combined fasinumab groups (19 events in 16 patients (3.8%) vs 1 event in 1 patient (0.7%) for placebo); all except one occurred in pOA patients.ConclusionsFasinumab highest doses, but not lower dose, improved both CLBP pain and function. Most joint AEs occurred in pOA patients, consistent with earlier findings in symptomatic OA. Further study is needed of patients with CLBP with and without pOA to determine optimal benefit–risk.

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