Low back pain surgery, the use of the Hartshill system

The Hartshill system is a modification of the Luque system of segmental spinal instrumentation. The philosophy of its use in low back pain is firstly the careful selection of patients. The method of selection will be discussed and attention will be drawn to one specific indication for low back surgery; namely, osteoarthritis of the lumbar facet joints. In any one patient the surgeon must be confident that the patient's pain is bad enough for surgery and that he has identified a definite pain source. The surgery should be designed to remove the pain source. If in the process of removing the pain source the spine is rendered unstable, then it is recommended that a fusion with internal fixation be performed. An independent review of our first 75 cases for osteoarthritis of the lumbar facet joints will be described. More recently we have recognized that in the lumbar spine it can be advantageous, particularly when there has been a wide laminectomy in the past, to gain fixation via the pedicle. The development and early clinical experience of a pedicle screw clamp to complement the Hartshill system will be described.