current concepts in management of lumbar disc prolapse
Post on 15-Apr-2017
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TRANSCRIPT
DISCECTOMY
Paul Licina
surgery is a last resort
these get better by
themselves
weakness doesn’t improve
more trouble in the future
HISTORY • pain for six weeks • leg pain > back pain • radicular pain EXAMINATION • nerve compression signs • nerve tension signs INVESTIGATIONS • MRI shows concordant herniation
THE PERFECT INDICATION
HISTORY • intolerable pain EXAMINATION • functional weakness INVESTIGATIONS • MRI shows huge herniation
EARLIER SURGERY
HISTORY • moderate pain for less than six weeks • nonradicular pain EXAMINATION • no positive supporting findings INVESTIGATIONS • MRI shows small herniation
ROLE OF STEROID NERVE ROOT BLOCK
BARRICAID TRIAL
all patients followed in trial since April 2014
52 discectomies performed
21 patients consented
6 Barricaid devices implanted
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