An Anatomic Approach to Minimally Invasive Spine Surgery
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Chronic disabling spinal pain with or without sciatica is a common condition that is a major medical and economic problem world wide. It can be precipitated by normal physiologic loading, may be multi-factorial, and not well understood. The spinal disc, however, is suspected to be the major cause of pain and the focus of most spine surgeries.
The two most common surgical procedures, discectomy and fusion, are currently the standard for treating lumbar disc herniations and for painful spinal disc degenerative disease believed by surgeons to be due to instability. Although discectomy, with proper patient selection, may have a reasonably good short term effect in relieving radicular pain, long term surgical morbidity may result in instability of the treated disc and may consequently speed the degenerative cascade and the resultant back pain.
Discectomy may lead to secondary sequella such as facet arthrosis and spinal stenosis by altering the biomechanical properties of the intervertebral disc. Fusion, likewise, is a non physiologic solution that may cause adjacent level problems. Although further decompression and/or fusion is the current “gold standard” for relieving this back pain and sciatica, its long term clinical success leaves much to be desired as a surgical procedure, prompting investigators to develop alternatives to fusion.
There is a great need for more effectiveand longer lasting treatments for low back and radicular pain from a scientific as well as an economic point of view.