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Nonoperative versus operative intervention in low back disorders.
1Department of Surgery, School of Medicine, University of California, San Diego 92103.
Seminars in Neurology
|September 1, 1989
Summary
This study reviews nonoperative and operative treatments for lumbosacral backache, emphasizing conservative care before surgical intervention. It highlights the preference for minimally invasive disc excision when surgery is necessary.
Area of Science:
- Neurosurgery
- Orthopedics
- Spinal Medicine
Background:
- Lumbosacral backache has numerous causes, not all requiring neurosurgical intervention.
- Nonoperative treatments are available and effective for many patients.
- Enzyme injections for disc dissolution have seen decreased use due to complications.
Purpose of the Study:
- To outline the differential diagnosis of lumbosacral backache.
- To review conservative management options for back pain.
- To discuss surgical interventions for refractory cases.
Main Methods:
- Review of nonoperative treatments including rest, injections, traction, and manipulation.
- Discussion of surgical procedures: percutaneous disc excision, laminotomy, and disc excision with fusion.
- Analysis of the decision-making process for selecting operative treatment.
Main Results:
- A range of nonoperative treatments can be employed with precautions.
- Surgical options vary from minimally invasive to fusion procedures.
- The optimal surgical approach for disc excision remains a subject of debate.
Conclusions:
- Conservative management should be attempted before considering surgery for lumbosacral backache.
- Minimally invasive disc excision is often preferred for its limited disruption of anatomy.