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Spinal instrumentation and attendant problems
Surgical Neurology 63 (2005) 349 www.surgicalneurology-online.com
Case Example
Spinal instrumentation and attendant problems Charles V. Burton, MD The Center for Restorative Spine Surgery, Minneapolis, MN 55407, USA Received 7 September 2004; accepted 5 October 2004
DH is a 58-year-old housewife who was incapacitated by low-back pain. She had been a pack-a-day smoker for 30 years. She was evaluated for her back pain in 2000. Her magnetic resonance imaging demonstrated multilevel degenerative changes throughout the lumbar spine, and 5-level discography confirmed that each level was degenerated and painful. On the basis of these findings, DH had a 5-level posterior pedicle screw-and-rod–instrumented fusion. Her postoperative course was complicated by failure of fusion, and over the past 4 years she had 6 revisions of her instrumentation and is still instrumented. At the time of her third revision, she sustained a pelvic fracture as a complication of the operative procedure. At this point, DH continues to smoke cigarettes, she takes morphine sulfate 90 mg 2 to 3 times per day, (Duragesic) patches 2 times per day, and (Percocet) 10/325 mg 4 times per day for pain control. A retrospective review of the patient’s imaging studies confirms an underlying genomic degenerative process.
1. Discussion It has been well demonstrated that smokers have a 3 to 4 times higher incidence of disc degeneration than nonsmokers. This incidence is even higher in the presence of genomic disease. DH would have been a good candidate initially for conservative spine care and a daily spine health maintenance program. The findings on discography should have been expected. Smokers also have a 3 to 4 times greater incidence of fusion failure than nonsmokers. Many spine surgeons today will require their patients to become nonsmokers before considering fusion. DH is now a classic example of the bfailed back surgery syndrome.Q In addition to her continuing discogenic pain, she now has a chronic pain syndrome and a chemical dependency problem. This case is another sad example of spine surgery creating more problems than it solves.
Liberty has never come from the government. Liberty has always come from the subjects of the government. The history of government is a history of resistance. The history of liberty is the history of the limitation of government, not the increase of it. —Woodrow Wilson (1856 –1924), U.S. president. Address, September 9, 1912, to the New York Press Club. The Public Papers of Woodrow Wilson, vol. 25, p. 124, ed. Arthur S. Link.
0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2004.10.031
Case Example
Spinal instrumentation and attendant problems Charles V. Burton, MD The Center for Restorative Spine Surgery, Minneapolis, MN 55407, USA Received 7 September 2004; accepted 5 October 2004
DH is a 58-year-old housewife who was incapacitated by low-back pain. She had been a pack-a-day smoker for 30 years. She was evaluated for her back pain in 2000. Her magnetic resonance imaging demonstrated multilevel degenerative changes throughout the lumbar spine, and 5-level discography confirmed that each level was degenerated and painful. On the basis of these findings, DH had a 5-level posterior pedicle screw-and-rod–instrumented fusion. Her postoperative course was complicated by failure of fusion, and over the past 4 years she had 6 revisions of her instrumentation and is still instrumented. At the time of her third revision, she sustained a pelvic fracture as a complication of the operative procedure. At this point, DH continues to smoke cigarettes, she takes morphine sulfate 90 mg 2 to 3 times per day, (Duragesic) patches 2 times per day, and (Percocet) 10/325 mg 4 times per day for pain control. A retrospective review of the patient’s imaging studies confirms an underlying genomic degenerative process.
1. Discussion It has been well demonstrated that smokers have a 3 to 4 times higher incidence of disc degeneration than nonsmokers. This incidence is even higher in the presence of genomic disease. DH would have been a good candidate initially for conservative spine care and a daily spine health maintenance program. The findings on discography should have been expected. Smokers also have a 3 to 4 times greater incidence of fusion failure than nonsmokers. Many spine surgeons today will require their patients to become nonsmokers before considering fusion. DH is now a classic example of the bfailed back surgery syndrome.Q In addition to her continuing discogenic pain, she now has a chronic pain syndrome and a chemical dependency problem. This case is another sad example of spine surgery creating more problems than it solves.
Liberty has never come from the government. Liberty has always come from the subjects of the government. The history of government is a history of resistance. The history of liberty is the history of the limitation of government, not the increase of it. —Woodrow Wilson (1856 –1924), U.S. president. Address, September 9, 1912, to the New York Press Club. The Public Papers of Woodrow Wilson, vol. 25, p. 124, ed. Arthur S. Link.
0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2004.10.031