Surgery for degenerative conditions of the

lumbar spine

Dr Paul Licina – Spine Surgeon

STABILITY

RESTABILISATION

INSTABILITY

DESSICATION  

OSTEOPHYTES  

STABILITY

RESTABILISATION

INSTABILITY

DESSICATION  

OSTEOPHYTES  

DISC HERNIATION

LOW BACK PAIN

STABILITY

RESTABILISATION

INSTABILITY

DESSICATION  

OSTEOPHYTES  

STENOSIS

DEFORMITY

MISCONCEPTIONS

surgery  is  a  last  resort  

weakness  doesn’t  improve  

more  trouble  in  the  future  

these  get  beDer  by  themselves  

THE PERFECT INDICATION

HISTORY •  pain for six weeks •  leg pain > back pain •  radicular pain

EXAMINATION •  nerve compression signs •  nerve tension signs

INVESTIGATIONS •  MRI shows concordant herniation

•  35  y.o.  male  •  6  week  history  of  severe  sciaJca  •  numbness  in  S1  distribuJon    

•  unable  to  single  heel  raise  on  right    •  right  calf  wasJng  •  right  SLR  limited  to  15°      

INDICATIONS FOR EARLIER SURGERY

HISTORY •  intolerable pain

EXAMINATION •  functional weakness

INVESTIGATIONS •  MRI shows huge herniation

•  33  y.o.  female  •  6  week  history  of  severe  sciaJca  •  bladder  dysfuncJon  and  perineal  

numbness  for  2  days    

•  too  painful  for  complete  assessment  •  reduced  bilateral  SLR    

INDICATIONS FOR STEROID INJECTION

HISTORY •  moderate pain for less than six weeks •  nonradicular pain

EXAMINATION •  no positive supporting findings

INVESTIGATIONS •  MRI shows small herniation

•  42  y.o.  female  •  4  week  history  of  sciaJca  •  iniJally  incapacitaJng,  now  improving    

•  no  numbness,  weakness  or  reflex  loss  •  right  SLR  limited  to  45°    

SPINAL STENOSIS

narrowing of the spinal canal with nerve compression What is it ?

leg pain and neurogenic claudication

What does it cause ?

SPINAL STENOSIS

when symptoms severe When do we operate ?

SURGERY IN THE FORM OF DECOMPRESSION

nonoperative treatment unsuccessful

Why do we operate ?

SPINAL STENOSIS

stenosis with instability • degenerative spondylolisthesis • degenerative scoliosis

When do we add fusion ?

SPONDYLOLISTHESIS SCOLIOSIS

Aetiology • due to degeneration of

facet joint • facet joint stability fails

and L4 slips forward on L5 • leads to spinal stenosis

DEGENERATIVE SPONDYLOLISTHESIS

DEGENERATIVE SCOLIOSIS

Aetiology • due to asymmetric

degeneration of disc and facet joint

• vertebral tilt leads to spinal deformity and

accelerated degeneration • associated spinal stenosis

Thank you