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Diagnostic approach in instability and irritative state of a “lumbar motion segment” following disc surgery—Failed back surgery syndrome

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Summary

A diagnostic protocol for patients with suspected instability and irritative state of a “lumbar motion segment” following lumbar disc surgery is presented and the results of internal fixation are analyzed.

In this group of patients the clinical picture and physical signs may be quite distinct and suggestive of instability and irritation of a “lumbar motion segment”, however, in isolation, they do not allow to decide upon surgery. Radiological studies favour a decision for surgery only in cases with an obvious instability of a “motion segment”. Anaesthethizing the articular nerves permits localization of the irritable segment and non-surgical therapeutic decisions (thermocoagulation) can only be taken in cases of an isolated facet-syndrome when instability has been ruled out. The trial plaster jacket holds the most important position with respect to the indication for internal fixation as demonstrated by the conformity of the results of the plaster jacket and the results of surgery.

After internal stabilization excellent, good, satisfactory and moderate results were obtained in 20, 3, 1 and 1 patients, respectively.

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References

  1. Bogduk N, Long DM (1979) The anatomy of the so-called “articular nerves” and their relationship to facer denervation in the treatment of low-back pain. J Neurosurg 51: 172–177

    PubMed  Google Scholar 

  2. Bogduk N, Long DM (1980) Percutaneous lumbar medial branch neurotomy: A modification of facet denervation. Spine 5: 193–200

    PubMed  Google Scholar 

  3. Canthen JC (1983) The etiology of the “failed back surgery syndrome”. In: Canthen JC (ed) Lumbar spine surgery. Williams & Wilkins, Baltimore, London, pp 190–203

    Google Scholar 

  4. Ebeling U, Reichenberg W, Reulen HJ (1986) Results of microsurgical discectomy. Acta Neurochir (Wien) 81: 45–52

    Google Scholar 

  5. Fairbanks JCT, Park WM, Mc Call IW, O'Brien JP (1981) Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine 6: 598–605

    PubMed  Google Scholar 

  6. Johnsson K-E, Willner S, Johnsson K (1986) Postoperative instability after decompression for lumbar spinal stenosis. Spine 11: 107–110

    PubMed  Google Scholar 

  7. Lee CK (1983) Lumbar spinal instability (Olisthesis) after extensive posterior spinal decompression. Spine 8: 429–433

    PubMed  Google Scholar 

  8. Long DM, Filtzer DL, BenDebba M, Hendler NH (1988) Clinical features of the failed-back syndrome. J Neurosurg 69: 61–71

    PubMed  Google Scholar 

  9. Louis R, Maresca C (1977) Stabilisation chirurgicale avec réduction des spondylolysis et des spondylolisthesis. Int Orthop 1: 215–225

    Google Scholar 

  10. Louis R (1986) Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop Relat Res 203: 18–33

    PubMed  Google Scholar 

  11. Louis F (1985) Spinal stability as defined by the three-column spine concept. Anat Clin 7: 33–42

    PubMed  Google Scholar 

  12. Magerl F (1985) Translaminäre Verschraubung der Intervertebralgelenke. In: Weber BG, Magerl F (eds) Fixateur externe. Springer, Berlin Heidelberg New York Tokyo, pp 304–305

    Google Scholar 

  13. Magerl F (1985) Der Wirbel-Fixateur externe. In: Weber BG, Magerl F (eds) Fixateur externe. Springer, Berlin Heidelberg New York Tokyo, pp 290–370

    Google Scholar 

  14. Paris SV (1985) Physical signs of instability. Spine 10: 277–279

    PubMed  Google Scholar 

  15. Rodegerdts U, Gisbertz D, Zielke K (1985) Untersuchung zur dorsalen Aufrichtungsosteotomie der Kyphose. Z Orthop 123: 374–379

    PubMed  Google Scholar 

  16. Schulitz KP, Lenz G (1984) Das Fazettsyndrom — Klinik und Therapie. In: Hohmann D, Kügelgen B, Liebig K, Schirmer M (eds) Neuroorthopädie 2. Springer, Berlin Heidelberg New York Tokyo, pp 543–550

    Google Scholar 

  17. Shenkin HA, Hash CJ (1979) Spondylolisthesis after multiple bilateral laminectomies and facetectomies for lumbar spondylosis. J Neurosurg 50: 45–47

    PubMed  Google Scholar 

  18. White AA, Panjabi MM (1978) Clinical biomechanics. Lippincott, Philadelphia, pp 35–42

    Google Scholar 

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The German term “Bewegungssegment” comprises all parts which are involved in the movements of one vertebral segment, i.g. disc, facet joints, ligaments and related muscles.

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Markwalder, T.M., Reulen, H.J. Diagnostic approach in instability and irritative state of a “lumbar motion segment” following disc surgery—Failed back surgery syndrome. Acta neurochir 99, 51–57 (1989). https://doi.org/10.1007/BF01407776

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