The external fixator: a tool for evaluation of complex low back pain problems

Area of Science:

• Spine surgery
• Orthopedics
• Pain management

Background:

• Selecting patients for low back pain fusion is challenging, especially after failed interventions or inconclusive diagnostic tests.
• External fixator testing offers a temporary simulation of internal fixation to aid patient selection.

Purpose of the Study:

• To determine if temporary pain relief from external fixation predicts long-term pain relief after spinal fusion surgery.

Main Methods:

• A retrospective study of 63 patients evaluated with external fixators for low back pain.
• Data collected included pain levels (Visual Analog Scale), medication use, and work status, reassessed at follow-up.
• Effectiveness of external fixation was categorized as positive, doubtful, or negative.

Main Results:

• External fixation improved pain in 38 patients, worsened it in 14, and had no effect in 11.
• Of those who underwent fusion, 72% (21/30) experienced improvement.
• Patients with a negative external fixation test had a poor prognosis regardless of further surgery.

Conclusions:

• External fixator testing is a valuable, albeit invasive, tool for selecting low back pain patients for spinal fusion, particularly when other methods fail.
• A positive test result predicts a 72% satisfactory outcome post-surgery, while a negative test identifies patients unlikely to benefit from further intervention.
• The primary utility lies in identifying patients who should *not* undergo surgery, thus avoiding unnecessary procedures and associated risks.