Minimally invasive spine surgery for low back pain

Abstract

ontraumatic low back pain is a disorder affecting up to 80% of the adult oplation. While it is often a self-limited condition, significant disability, oss of productive years in the work force, and chronic pain may evelop. Studies have shown that chronic low back pain with a resulting bsence from work for 1 year leads to only 25% of patients returning to he work force. Furthermore, despite advances in treatment, the problem emains a major social problem in the United States. In 1994 The Agency for Health Care Policy and Research published a linical Practice Guideline entitled “Acute Low Back Pain Problems in dults,” with a listing of “red flags” on history and physical exam. These red flags” suggest the possibility of a serious disorder as the cause of ack pain. Historic “red flags” include constitutional symptoms (weight oss, fevers, chills, fatigue, night sweats), pain worse at night or while upine, and history of recent infection, immunosuppresion, trauma, or ancer. Physical examination “red flags” include severe tenderness, ilateral neurologic deficits, saddle anesthesia, and pain out of proportion o physical findings. Severe underlying disorders to be identified early in n episode of back pain include spinal infection, spinal tumors, fractures, nd cauda equina syndrome. Suspicion of any of these should prompt mmediate diagnostic testing to rule out the condition. In the absence of any “red flags” on initial evaluation, treatment may be nstituted without any further diagnostic testing. Plain radiographs are btained initially only if a “red flag” is identified or in patients at extremes f age, older than 60 years or younger than 15 years, or if symptoms have een present for 4 to 6 weeks or longer. Of all cases of mechanical low ack pain, 70% are due to lumbar strain or sprain, 10% are due to egenerative changes in discs and facets, 4% of cases are due to herniated iscs, 4% are due to osteoporotic compression fractures, and 3% are due