Lateral Lumbar Interbody Fusion
Introduction An exponential rise in rates of spinal surgery over the past decade has been dominated by a concomitant increase in the utilization of intervertebral cages for spinal fusion. The…
Instrumentation Options
Introduction Despite excellent outcomes for carefully selected patients undergoing surgical management of lumbar spine pathology, a small but significant subset of patients will have persistent or recurrent symptomatology. Unfortunately, some…
Disc Herniation (Primary, Recurrent, Residual)
Introduction Lumbar intervertebral discs are complex structures subjected to significant axial compressive forces. Because of biomechanical demands and the inability to remodel as a result of an avascular nature, lumbar…
Imaging Considerations (Magnetic Resonance, Computed Tomography, Myelography, Plain)
Introduction Regardless of the presence of lumbar instrumentation, recurrent symptoms after a lumbar decompressive surgery are not uncommon; for example, after undergoing microlumbar discectomy up to 12% of patients may…
Dural Scarring and Repair Issues
Background A vast majority (up to 80%) of the US population are estimated to experience an episode of low back pain (LBP) during their lifetime. A subset of these individuals…
Decompression
Introduction Lumbar spine disorders and the disabling pain associated with these conditions are associated with significant healthcare resource use and costs in the United States. Of these patients, an estimated…
Anatomy and Physiology/Biology of Bone
Anatomy Lumbar Spine Make-Up The typical vertebral column is composed of 33 vertebrae. The lumbar spine usually has five mobile lumbar vertebrae, denoted as L1–L5. As a group, the lumbar…
Indications
Background Revision lumbar spine surgery is predominantly associated with several distinct pathological processes resulting from an initial index surgery. For example, in the treatment of disc herniations, residual stenosis and…
Medical Fitness Evaluation
Introduction One major issue when considering reconstructive spinal surgery is medical fitness for surgery. This is defined as an individual’s ability to sustain the physiological stress of surgery and recovery….
The Role of Osteoporosis and Bone Diseases in Revision Spine Surgery
Introduction Poor bone health can lead to failure of the primary spinal procedure and precipitate the need for a revision spine surgery. Postoperative complications related to poor bone health include…
