Back - Thoracic and Lumbar Spine

Five percent of the United States population experiences back pain each year (1). Over your lifetime, you have a 60-80% chance of experiencing at least one episode of back pain. Most episodes are not severe and resolve without medical care. Some, however, are severe and disabling. But even the more severe cases which cause patients to seek medical or chiropractic care are usually transient. It has been estimated that 90% of patients who seek professional treatment for back pain will be pain free within 1-3 months. In this group of patients, after ruling out an underlying systemic cause such as a malignancy or infection, appropriate care consists of providing conservative treatment.

The gold standard of conservative treatment consists of management with NSAIDS (Non Steroidal Anti Inflammatory Drugs) and exercise therapy (chiropractic or physical therapy). If these modalities fail after a 3-6 week trial, referral to a specialist (neurosurgeon or orthopedic surgeon) is appropriate. Often, we as specialists will continue conservative measures. When this fails, surgery can be extremely effective. Surgery is only performed when conservative measures fail and diagnostic tests demonstrate abnormalities.

In our practice, the most frequently encountered causes of nerve impingement in the lumbar spine are herniated disk, spinal stenosis and painful mechanical instability with degenerated disk.

Lumbar Percutaneous Pedicle Screws

Fusions are performed in patients with degenerative disk disease, spondylolysthesis, recurrent herniated disks, and spinal stenosis. Fusion is performed in these patients when conservative forms of treatment have failed. In fusion of the lumbar spine two or more vertebral segments are joined together, eliminating movement in the joints. The procedure is performed with the hope of reducing pain caused by movement and compression of the nerve roots.

Pedicle screws have long been used to provide structural support to the spine allowing the joint space between the vertebral bodies to fuse. Screws are inserted into the pedicle of the vertebrae at the level above and below the disk space to be fused. A rod is then attached to solidly link both pedicle screws.

During the placement of conventional pedicle screws a considerable amount of muscle must be cut and stripped away from the bone in order to insert the screws. This can result in a lengthy healing time and considerable post operative pain for the patient. Minimally invasive percutaneous pedicle screw and rod placement eliminates the need to perform much of this cutting and stripping of muscle.

The percutaneous pedicle screw system (Medtronic’s Sextant is shown here) allows the screws and rods to be placed through small puncture wounds in the skin under x-ray fluoroscopic guidance.

The Buffalo Neurosurgery Group performs pedicle screw lumbar procedures to provide structural support to the spine allowing the joint space between the vertebrae to fuse. Screws are inserted into the pedicle of the vertebrae at the level above and below the disk space to be fused. A rod is then attached to securely link both pedicle screws. The percutaneous pedicle screw system (Medtronic Sextant) allows the screws and rods to be placed through small puncture wounds in the skin.

A considerable amount of muscle must be cut and stripped away from the bone to insert the screws. This can result in lengthier healing times and a considerable amount of post-op pain. Minimally invasive percutaneous pedicle screw and rod placement eliminates the need to cut and strip the muscle tissue.

This description is a general overview. Your Buffalo Neurosurgery Group doctor will provide the details of the correct procedure for you. He will also explain the health benefits, risks and special pre and post-op care instructions.

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