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MULTIPLE OPERATIONS FOR A LUMBAR DISC LESION 1
Author(s) -
SELECKI BORYS R.,
NESS THOMAS D.
Publication year - 1982
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1982.tb05394.x
Subject(s) - medicine , arachnoiditis , laminectomy , surgery , discectomy , lumbar , neurotomy , spinal fusion , neurosurgery , dissection (medical) , nerve root , spinal cord , psychiatry
Lumbar spinal disability ranks amongst the most important causes of permanent disability in the community. Patients with a history of multiple lumbar spinal operations form an important group amongst the permanently disabled. Two thousand, six hundred and forty‐two spinal operations were carried out in New South Wales in 1977; an estimated 75% by orthopaedic surgeons and 25% by neurosurgeons. One in three patients operated upon underwent spinal fusion. Ninety percent of all the procedures were carried out In the Metropolitcan and Hunter Regions. An estimated 22% of patients operated on for a lumbar disc lesion underwent more than one surgical procedure. The common pattern of multiple operations comprises first laminectomy or interlaminar discectomy, second, either spinal fusion and/or dissection of adhesions or removal of disc sequesters, and third, various combinations of previous procedures. The patients' long term prognosis deteriorates with every subsequent procedure. After two to three unsuccessful attempts, the patient becomes permanently disabled by intractable pain and not uncommonly addicted to hard drugs. The underlying pathology at that late stage is most often intrinsic root damage (root fibrosis) and arachnoiditis. Neurosurgical procedures for intractable pain such as rhizotomy, neurotomy and spino‐thalamlc tractotomy carry a varying degree of success in providing last relief from pain, but do not relieve permanent spinal disability in the patient who has had multiple operations. The preventable causes for multiple surgery may originate in poor judgement in diagnosis, ill defined indications for surgery and may be compounded by poor surgical technique. These are discussed in some detail. Not all multiple surgery can be eliminated, but a significant part of it can be prevented through better standards of diagnostic assessment, clearer and more stringent definition of Indications and improved surgical technique. This can only be achieved through closer neurosurgical and orthopaedic collaboration in the training of young surgeons and systematic exchange of clinical experience in diagnosis, indications for surgery and surgical techniques between the two specialties.