CHRONIC BACK PAIN
Most people have experienced back pain during their lifetime. Generally it will resolve quite quickly by itself, with just a little help
from an anti inflammatory drug. Only a few people have such disabling pain that it can not relieved by alternative treatment.
So, when you have tried manipulation, acupuncture, physiotherapy and medication without relief for about 6-12 months, surgery
may be an option. It is very important not to rush into a surgical procedure until all the details of the pain problem are disclosed. It
is essential to find a specialist in Spinal surgery with which to discuss with.
The method of choice for chronic low back pain is fixation and fusion. The golden standard is a fusion without screw fixation,
follwed by the wearing of a stiff brace for 6 months. However you have to be realistic. The treatment will only effect good pain
relief in about 60% of all cases. In addition, there is a long rehabilitation and you may need repeated surgery due to delayed
Smoking cigarettes will decrease bone healing by 40%. Also joints adjacent to the fusion area can be painful and decrease your
function. Considering body function it is a pity to sacrifice the flexibility of the spine. Today, generally, no one considers arthrodesis
(fixation) as a treatment for arthrosis of the hip or knee joint. For these joints arthroplasty (replacement works quite well. Dr U.
Fernstrom, an Orthopaedic surgeon working in Sweden in the 1960's, became interested in the subject. He cooperated with a big
manufacturer of ball bearings known as SKF. At the time he was laughed out of the operating theatre when he implanted big
metallic bearing balls in the disks of his patients. Now however, 30 years later, his work has been fully acknowledged. His simple
method proved to be extremely successful in relieving pain and more than 90% of his patients returned to their jobs.
A few artificial disks are now commercially available and well studied. One type of disk is quite like the one used in hip
replacements. It has been proved to be safe and reliable for more than 10 years. But due to the specialised nature of this technique
there are not many spinal surgeons who are familiar with this procedure.
Before the final decision about appropriate treatment you have to go through a great deal of examinations. If you have spinal
stenosis with pressure on nerve roots and leg pain you probably need a decompression and posterior fixation. If your problems are
limited to the disks, however you can consider the aforementioned artificial disks. The operation is performed with a minimal
invasive surgical anterior approach, a fairly new technique which makes early mobilisation possible. It is performed under general
anaesthesia and the patient sleeps through the whole operation. Generally the bleeding is minor.
Prophylactic antibiotics and anti-trombotic medication are prescribed. The degenerated disk is taken out and the implant put in
using quite specific instrumentation. Due to the operative technique you do not need to wait for healing to occur. After the first
evening you are permitted to sit on the bed and walk to the bathroom. A couple of days later most of the patients will be out
drinking coffee in the bar.