Necessary or unnecessary? a critical glance on spine surgery

Raabe, Andreas; Beck, Jürgen; Ulrich, Christian T. (2014). Necessary or unnecessary? a critical glance on spine surgery. Therapeutische Umschau, 71(12), pp. 701-705. Huber 10.1024/0040-5930/a000614

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Patients with complaints and symptoms caused by spinal degenerative diseases demonstrate a high rate of spontaneous improvement. Except of severe neurological symptoms such as high grade motor deficits, medically intractable pain and vegetative symptoms (cauda syndrome) operations require 1) symptoms, 2) a mechanical cause visible on imaging that sufficiently explains the symptoms, 3) a completed conservative treatment protocol performed over a 4) 6-12 week period. According to the evidence found in the literature, patients with lumbar disk herniation significantly benefit from surgery by a faster relieve of pain and return to social and professional activity, however, the results are converging after a period of 1-2 years. Surgery of lumbar spinal stenosis is considered a gold standard and superior to conservative care when symptoms are severe and leg pain is present. Bilateral microsurgical decompression using a bilateral or a unilateral approach with over-the-top decompression of the contralateral nerve root are superior to laminectomy as the decompression procedure. Lumbar fusion is only indicated in patients with spinal stenosis when a major or mobile spondylolisthesis is diagnosed. There is no indication of prophylactic surgery to avoid a "dangerous" deficit that might develop in the future.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Raabe, Andreas; Beck, Jürgen and Ulrich, Christian T.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0040-5930

Publisher:

Huber

Language:

German

Submitter:

Nicole Söll

Date Deposited:

13 Mar 2015 16:58

Last Modified:

26 Apr 2016 08:26

Publisher DOI:

10.1024/0040-5930/a000614

PubMed ID:

25447083

URI:

https://boris.unibe.ch/id/eprint/64539

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