Surgery for common degenerative conditions

of the lumbar spine

Dr Paul Licina – Spine SurgeonDr Adrian Nowitzke – Neurosurgeon

DISC HERNIATION

Whatcauses it ?

What does it cause ?

DISC HERNIATION

How do we treat it?

DISC HERNIATION

When do we operate ?

THE PERFECT INDICATION

HISTORY• pain for six weeks• leg pain > back pain• radicular pain

EXAMINATION• nerve compression signs• nerve tension signs

INVESTIGATIONS• MRI shows concordant herniation

• 35y.o.male• 6weekhistoryofseveresciatica• numbness inS1distribution

• unabletosingleheelraiseonright• rightcalfwasting• rightSLRlimitedto15°

DISC HERNIATION

When do we operate earlier

?

INDICATIONS FOR EARLIER SURGERY

HISTORY• intolerable pain

EXAMINATION• significant neurological deficit

INVESTIGATIONS• MRI shows huge herniation

• 33y.o.female• 6 weekhistoryofseveresciatica• bladderdysfunctionandperineal

numbnessfor2days

• toopainfulforcompleteassessment• reducedbilateralSLR

INDICATIONS FOR STEROID INJECTION

HISTORY• moderate pain for less than six weeks• nonradicular pain

EXAMINATION• no positive supporting findings

INVESTIGATIONS• MRI shows small herniation

• 42y.o.female• 4 weekhistoryofsciatica• initially incapacitating,nowimproving

• nonumbness,weaknessorreflexloss• rightSLRlimitedto45°

MISCONCEPTIONS

surgeryisalastresort

weaknessdoesn’timprove

moretroubleinthefuture

thesegetbetterbythemselves

SPINAL STENOSIS

What is it ?

What does it cause ?

SPINAL STENOSIS

When do we operate ?

SPINAL STENOSIS

When do we add fusion ?

SPONDYLOLISTHESIS SCOLIOSIS

DEGENERATIVE SPONDYLOLISTHESIS

DEGENERATIVE SCOLIOSIS

Thank you