Focused Issue of This Month Surgical Management of Chronic Low Back Pain TaeAhn Jahng, MD Department of Neurosurgery, Seoul National Univeristy College of Medicie Email : taj@snu.ac.kr J Korean Med Assoc 2007; 50(6): 523-532 Abstract Conservative therapy remains the mainstay treatment of chronic low back pain (LBP). If this has failed, surgical options may be considered in carefully selected patients. Still surgical treatment for chronic LBP is a matter of intensive and controversial discussions. Nevertheless, surgical management for chronic (LBP) has been evolved and increased gradually. Spinal fusion has been the established surgical option in cases that did not respond to conservative therapy. Besides spinal fusion, newer technologies such as artificial disc replacement, dynamic stabilization, and spinal cord stimulation are being increasingly considered. Although successful results of these procedures have been published, evidencebased data on the efficacy and benefits of most of these techniques are still lacking. However, empirical data show good or at least satisfactory clinical results of these procedures when they were applied under restrictive indication criteria. Further prospective randomized controlled studies are mandatory to determine the role of these procedures, and basic research is necessary to understand the pathogenesis of LBP at the molecular and genetic levels Keywords : Chronic low back pain; Surgical management; Spinal fusion; Artificial disc; Dynamic stabilization; Spinal cord stimulation 523
Jahng TA Figure 1. Schemas of posterolateral fusion techniques. 524
Surgical Management of CLBP Figure 2. Depiction of anterior lumbar interbody fusion(alif, left) and posterior interbody fusion(plif, middle), and postoperative lateral Xray of PLIF (right). 525
Jahng TA é 526
Surgical Management of CLBP A B Figure 4. Charite artificial disc (upper) and postoperative AP and lateral Xray after total disc replacement with Charite artificial disc (right A & B). Figure 3. PDN artificial nucleus (upper) and postoperative lateral Xray after PDN nucleus replacement. 527
Jahng TA Figure 5. Dynesys stabilization system consist of pedicle screw and spacer, and polyethylene cord (left) and postoperative Xray (middle and right). é 528
Surgical Management of CLBP Figure 6. NFlex dynamic stabilization system (left) and postoperative flexion/extension view shows maintenance of motion at L3L4 (middle and right). 529
Jahng TA Figure 7. Spinal cord stimulation leads (left upper) and totally implantable pulse generators (left lower), and postoperative AP Xray shows lead and generator (right). 530
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