Image Sources
Reviewer
James S Harrop, MD, FACS
Professor, Departments of Neurological and Orthopedic Surgery
Director, Division of Spine and Peripheral Nerve Surgery
Neurosurgery Director of Delaware Valley SCI Center
Thomas Jefferson University
Philadelphia, PA
Disclosure: James S Harrop, MD, FACS, has acted as a consultant to Ethicon and has served on the scientific advisory committee for Bioventus, Tejin, and Asterias.
Photographer
Anne Vinsel, MS, MFA
Project Administrator
Graduate Medical Education Department
University of Utah
Salt Lake City, UT
Disclosure: Anne Vinsel, MS, MFA, has disclosed no relevant financial relationships.
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Reviewer: James S Harrop, MD, FACS; Photographer: Anne Vinsel, MS, MFA | April 3, 2017
Lumbar spinal stenosis is a common cause of low back and leg pain and disability in adults, and it is often caused by spondylolisthesis (spinal slippage).[1] Patients who do not improve after 3-6 months of nonoperative therapy (eg, physical therapy, pain management, acupuncture, or chiropractic) may consider surgical decompression as an option.[2]
Spinal decompression surgery (laminectomy) removes the compressive structures, including hypertrophic ligamentum flavum and lumbar facet joint osteophytes.
The goals of surgical treatment are to alleviate neural compression (decompression) and, in selected patients with a deformity or instability, to stabilize the spine (fusion), so as to prevent further spinal compression and recurrent symptoms.[3-8]
Image courtesy of Wikimedia Commons.
In selected patients (eg, those with a deformity or spondylolisthesis), a spinal fusion with instrumentation is required. Spinal pedicle screws with connecting rods provide direct fixation into the vertebrae and increase spinal stability, thereby improving the chances of successful fusion. A successful spinal fusion requires osseous growth of the vertebrae and the bone graft together.
Image courtesy of Anne Vinsel, MS, MFA.
Successful spinal fusion also requires bone grafting. The autograft bone provides a source for bone-forming cells (osteogenesis), a means of stimulating bone growth (osteoinduction), and a structure on which new bone can grow (osteoconduction).
Bone graft sources vary, depending on the patient and the surgeon's preference. The historical gold standard is autogenous bone graft from the iliac crest. As a result of the limitations of this type of graft, newer biologics are being used in combination with alternative bone grafts (eg, local autograft bone obtained during decompression).
In this case, the surgeon used a combination of local bone graft and recombinant human bone morphogenetic protein-2 (rhBMP-2) for the posterior fusion (an off-label use of the product).
Image courtesy of Anne Vinsel, MS, MFA.
An upright lateral postoperative radiograph shows the rod and pedicle screws in good position.
Patients tend to experience resolution of their leg symptoms immediately after surgery and are encouraged to ambulate. The incision typically heals over the following 2-3 weeks, and the incisional pain continually improves. The main concern at this point is to be alert for new pain or weakness. In addition, any fever, drainage from the wound, or worsening symptoms should be discussed with the surgical team.
Image courtesy of Anne Vinsel, MS, MFA.
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