MEDICOLEGAL ASPECTS OF BACK CONDITIONS
The role of surgeryin commonlumbar conditions
Paul Licina
disc herniation
discogenic pain
spinal stenosis
4
WHAT CAUSES IT?WHO YOU AREWHAT YOU DOWHAT HAPPENED
genetics weightfitnesspsychologyageWHO YOU AREWHAT CAUSES
IT?
WHAT YOU DOoccupationpastimesWHAT CAUSES IT?previous
injuriessmoking
WHAT HAPPENEDinjuryrepetitive loadWHAT CAUSES IT?
WHO YOU AREWHAT YOU DOWHAT HAPPENEDWHAT CAUSES IT?
WHAT CAUSES IT?The once commonly held view that disc
degeneration is primarily a result of aging and wear and tear from
mechanical insults and injuries was not supported by this series of
studies. Instead, disc degeneration appears to be determined in
great part by genetic influences. Although environmental factors
also play a role, it is not primarily through routine physical
loading exposures (eg, heavy vs. light physical demands) as once
suspected.Previously, heavy physical loading was the main suspected
risk factor for disc degeneration.Recent research indicates that
heredity has a dominant role in disc degeneration, explaining 74%
of the variance in adult populations studied to date.The Twin Spine
Study Battie et al.
WHO YOU AREWHAT YOU DOWHAT HAPPENEDWHAT CAUSES IT?
Age (yr)20406080Disc degeneration37%68%88%96%Disc
protrusion29%33%38%43%
DISC HERNIATIONtear in outer disc (brittle)migration of inner
gel (lumpy)not usually traumaticdoes not occur in a normal discWhat
causes it ?nerve pressureleg pain (sciatica)What does it cause
?
What happens to it ?two phases of
paininflammationcompressioninflammation can be reversedfragment can
be resorbedrough guide50% better in 4 wks90% resolve eventuallyDISC
HERNIATION
radicular painparasthesiaeback painWhat are the symptoms?reduced
straight leg raiseweaknessreflex losssensory lossWhat are the signs
?
DISC HERNIATION
observe (physiotherapy)nerve root blockNerve root blockinjection
of local anaesthetic (Marcain) and cortisone (Celestone)into nerve
root foramenunder CT guidanceusually temporarygood if surgery not
indicatedgood for diagnosis if in doubtHow do we treat
it?surgeryDISC HERNIATION
cauda equina syndromeunremitting painPrerequisitessymptoms >
6 weeks (?4 weeks)leg pain > back painleg pain in radicular
distributionnerve tension signs (reduced SLR)nerve compression
signsconfirmed on imagingWhen do we operate ?
SURGERY IN THE FORM OF DISCECTOMYrelief of leg painWhy do we
operate ?Outcomesatisfactory result in 90%DISC HERNIATIONfunctional
weaknessdecompression of nerve
Patient information discectomy video
OutcomeDay Surgery procedureBack to sedentary duties by 3
weeksBack to sport by 6 weeksGood or excellent result in
90%Recurrence rate 6%Disabling low back pain
