DISCECTOMY

Paul Licina

surgery is a last resort

these get better by

themselves

weakness doesn’t improve

more trouble in the future

HISTORY • pain for six weeks • leg pain > back pain • radicular pain EXAMINATION • nerve compression signs • nerve tension signs INVESTIGATIONS • MRI shows concordant herniation

THE PERFECT INDICATION

HISTORY • intolerable pain EXAMINATION • functional weakness INVESTIGATIONS • MRI shows huge herniation

EARLIER SURGERY

HISTORY • moderate pain for less than six weeks • nonradicular pain EXAMINATION • no positive supporting findings INVESTIGATIONS • MRI shows small herniation

ROLE OF STEROID NERVE ROOT BLOCK

BARRICAID TRIAL

all patients followed in trial since April 2014

52 discectomies performed

21 patients consented

6 Barricaid devices implanted