Advertisement

The Surgeon’s Perspective: Image-Guided Therapy and Its Relationship to Conventional Surgical Management

  • F. Todd Wetzel
  • Frank M. Phillips

Conclusion

From the point of view of planning surgical intervention, a diagnostic test must be sensitive, specific, and reproducible. The patient’s clinical findings must be precisely supported by the results of the diagnostic intervention. A well-studied surgical procedure to treat the specific pathology must be identified. Clearly, in many of the diagnostic regimens reviewed, the very nature of the tests (especially those involving pain provocation or ablation) may preclude the achievement of full sensitivity. Thus, the practical utility of a particular study in the matrix of clinical evaluation and subsequent surgical planning is of crucial importance. Appropriate patient selection and education about expected outcomes are vital to identify patients who will have a successful surgical outcome. Ideally, the indications and expectations should be identical in the minds of the diagnostician and the surgeon.

Finally, in many instances, more rigorous study of both diagnostic and surgical procedures is required. It is perhaps the greatest temptation of the clinician scientist to utilize promising techniques or procedures in an effort to alleviate patients’ suffering for apparent problems before the techniques have been completely evaluated. Thus the exercise of compassionate restraint may be the greatest challenge facing clinicians today.

Keywords

Lumbar Spinal Stenosis Percutaneous Vertebroplasty Epidural Steroid Injection Osteoporotic Vertebral Compression Fracture Discogenic Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Morris EW, DiPada M, Vallance R, Waddell G. Diagnosis and decision making in lumbar disc prolapse and nerve entrapment. Spine 11(5):436–439, 1986.PubMedGoogle Scholar
  2. 2.
    Fischgrund JS, Mackay M. Herkowitz HN, et al. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812, 1997.CrossRefPubMedGoogle Scholar
  3. 3.
    Wetzel FT, La Rocca H, Lowery GL, Aprill CN. The treatment of lumbar spinal pain syndromes diagnosed by discography. Spine 19(7):792–800, 1994.PubMedGoogle Scholar
  4. 4.
    Esses S, Moro J. The value of facet joint blocks in patient selection for lumbar fusion. Spine 18(2):185–190, 1993.PubMedGoogle Scholar
  5. 5.
    Carragee EJ, Paragioudakis SJ, Khurana S. Lumbar high-intensity zone and discography in subjects without low back problems. Spine 25(23):2987–2992, 2000.CrossRefPubMedGoogle Scholar
  6. 6.
    Carragee EJ, Tanner CM, Khurana S, Hayward C, et al. The rates of false positive lumbar discography in selected patients without low back symptoms. Spine 25(11):1373–1381, 2000.CrossRefPubMedGoogle Scholar
  7. 7.
    Carragee EJ, Tanner CM, Yang B, et al. False-positive findings on lumbar discography reliability of subjective concordance assessment during provocative disc injection. Spine 24:2542–2547, 1999.CrossRefPubMedGoogle Scholar
  8. 8.
    Fritzell H, Hogg O, Wessberg P, et al. Lumbar fusion versus non-surgical treatment for chronic low back pain. Spine 26:2521–2534, 2001.CrossRefPubMedGoogle Scholar
  9. 9.
    Dreyfuss PA, Schwarzer A, Lau P, Bogduk N. Specificity of lumbar medial branch and L5 dorsal ramus blocks: a computed tomography study. Spine 22(8):895–902, 1999.CrossRefGoogle Scholar
  10. 10.
    Airaksinen O, Herno A, Turunen V, et al. Surgical outcome of 438 patients treated surgically for lumbar spinal stenosis. Spine 22:2278–2287, 1997.CrossRefPubMedGoogle Scholar
  11. 11.
    Barnes D, Gatchel RJ, Mayer TG, et al. Changes in MMPI profile levels of chronic low-back-pain patients following successful treatment. J Spinal Disord, 3:353–358, 1990.PubMedGoogle Scholar
  12. 12.
    Kanner AD, Coyne JC, Schaefer C, Lazarus RS. Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. J Behav Med 4:1–39, 1981.CrossRefPubMedGoogle Scholar
  13. 13.
    Pheasant HC, Gilbert D, Goldfard J. Herron LD. The MMPI as a predictor of outcome in low-back surgery. Spine 4:78–84, 1979.PubMedGoogle Scholar
  14. 14.
    Sternbach RA. Psychological aspects of chronic pain. Clin Orthop 129:150–155, 1977.PubMedGoogle Scholar
  15. 15.
    Grubb SA, Lipscomb HJ, Guilford WB. A relative value of lumbar roentgenograms, metrizamide myelography, and discography in the assessment of patients with chronic low back syndrome. Spine 12:282–286, 1987.PubMedGoogle Scholar
  16. 16.
    Walsh TR, Weinstein JN, Spratt KF, Lehmann TR, Aprill C, Sayreh H. Lumbar discography in normal subjects. J Bone Joint Surg (Am) 72:1081–1088, 1990.Google Scholar
  17. 17.
    Saal JS. General principles of diagnostic testing as related to painful lumbar spine disorders: A critical appraisal of current diagnostic techniques. Spine 27(22):2538–2546, 2002.CrossRefPubMedGoogle Scholar
  18. 18.
    Crock H. Internal disc disruption. Spine 11:650–653, 1986.PubMedGoogle Scholar
  19. 19.
    Saal JA, Saal JS. Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine 14(4):431–437, 1989.PubMedGoogle Scholar
  20. 20.
    Parker L, Murrell S, Boden S, Horton W. The outcome of posterolateral fusion in highly selected patients with discogenic low back pain. Spine 21(16): 1909–1917, 1996.CrossRefPubMedGoogle Scholar
  21. 21.
    Donelson R, Silva G, Murphy K. The centralization phenomenon: its usefulness in evaluating and treating referred pain. Spine 15(3):211–213, 1990.PubMedGoogle Scholar
  22. 22.
    Karas R, McIntosh G, Hall H, Wilson L, Melles T. The relationship between nonorganic signs and centralization of symptoms in the prediction of return to work for patients with low back pain. Phys Ther 77(4):354–360, 1997.PubMedGoogle Scholar
  23. 23.
    Long A. The centralization phenomenon: its usefulness as a predictor of outcome in conservative treatment of chronic low back pain. Spine 20(23): 2513–2521, 1995.PubMedGoogle Scholar
  24. 24.
    Sufka A, Hauger B, Trenary M, Hagan A, Lozon R, Martens B. Centralization of low back pain and perceived functional outcome. J Orthop Sports Phys Ther 27(3):205–212, 1998.PubMedGoogle Scholar
  25. 25.
    Werneke M, Hart DL. Cook D. A descriptive study of the centralization phenomenon. A prospective analysis. Spine 24(7):676–683, 1999.CrossRefPubMedGoogle Scholar
  26. 26.
    Werneke M, Hart DL. Centralization phenomenon as a prognostic factor for chronic low back pain and disability. Spine 26(7):758–765, 2001.CrossRefPubMedGoogle Scholar
  27. 27.
    Kopp JR, Alexander AH, Turocy RH, Levrini MG, Lichtman DM. The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus, a preliminary report. Clin Orthop 202:211–218, 1986.PubMedGoogle Scholar
  28. 28.
    Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain: a predictor of symptomatic discs and anular competence. Spine 22(10):1115–1122, 1997.CrossRefPubMedGoogle Scholar
  29. 29.
    McKenzie R. The Lumbar Spine: Mechanical Diagnosis and Therapy. Waikanae, New Zealand: Spinal Publications, 1981.Google Scholar
  30. 30.
    Derby R, Howard MW, Grant JM, et al. The ability of pressure-controlled discography to predict surgical and nonsurgical outcomes. Spine 24:364–372, 1999.CrossRefPubMedGoogle Scholar
  31. 31.
    Whitecloud TS III, Seago RA. Cervical discogenic syndrome. Results of operative intervention in patients with positive discography. Spine 12:313–316, 1987.PubMedGoogle Scholar
  32. 32.
    Wood KB, Schellhas KP, Garvey TA, et al. Thoracic discography in healthy individuals. Spine 24:1548–1555, 1999.CrossRefPubMedGoogle Scholar
  33. 33.
    Marks R. Distribution of pain provoked from lumbar facet joints and related structures during diagnostic spinal infiltration. Pain 39:37–40, 1989.CrossRefPubMedGoogle Scholar
  34. 34.
    McCall IW. Induced pain referral from posterior lumbar elements in normal subjects. Spine 4:441–416, 1979.PubMedGoogle Scholar
  35. 35.
    Mooney V, Robertson J. The facet syndrome. Clin Orthop 115:149–156, 1976.PubMedGoogle Scholar
  36. 36.
    Schwarzer AC, Wang S, Bogduk N, McNaught PJ, Laurent R. The prevalence and clinical features of lumbar zygapophysial joint pain: a study in an Australian population with chronic low back pain. Ann Rheum Dis 54:100–106, 1995.PubMedCrossRefGoogle Scholar
  37. 37.
    Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The falsepositive response rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain 58:195–200, 1994.CrossRefPubMedGoogle Scholar
  38. 38.
    Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. Clinical features of patients with pain stemming from the lumbar zygapophysial joints: is the lumbar facet syndrome a clinical entity? Spine 19:1132–1137, 1994.PubMedGoogle Scholar
  39. 39.
    Jackson RP. The facet syndrome: myth or reality? Clin Orthop 279:110–121, 1992.PubMedGoogle Scholar
  40. 40.
    Kaplan M, Dreyfuss P, Halbrook B, et al. The ability of lumbar medial branch block to anesthetize the zygapophyseal joint. Spine 23:1847–1852, 1998.CrossRefPubMedGoogle Scholar
  41. 41.
    Revel M, Listrat V, Chevalier X, et al. Facet joint block for low back pain: identifying predictors of a good response. Arch Phys Med Rehab 73:824–828, 1992.Google Scholar
  42. 42.
    North R, Kidd D, Zahurack M, Piantadosi D. Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease. Pain 65:77–85, 1996.CrossRefPubMedGoogle Scholar
  43. 43.
    Barnsley L, Lord SM, Bogduk N. Comparative local and anesthetic blocks in the diagnosis of cervical zygapophysial joint pain. Pain 55:99–106, 1993.CrossRefPubMedGoogle Scholar
  44. 44.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. False-positive rates of cervical zygapophysial joint blocks. Clin J Pain 9:124–130, 1993.PubMedGoogle Scholar
  45. 45.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. Lack of effect of intra-articular corticosteroids for chronic pain in the cervical zygapophysial joints. N Engl J Med 330(15):1047–1050, 1994.CrossRefPubMedGoogle Scholar
  46. 46.
    Barnsley L, Lord SM, Wallis BJ, Bogduk N. Chronic cervical zygapophysial joint pain after whiplash: a prospective prevalence study. Spine 20:20–26, 1995.PubMedGoogle Scholar
  47. 47.
    Lord SM, Barnsley L, Bogduk N. Percutaneous radiofrequency neurotomy in the treatment of cervical zygapophysial joint pain: a caution. Neurosurgery 36:732–739, 1995.PubMedGoogle Scholar
  48. 48.
    Slipman C, Jackson H, Lipetz J, Chan K, Lenrow D, Vresilovic E. Sacroiliac joint pain referral zones. Arch Phys Med Rehabil 81:334–338, 2000.CrossRefPubMedGoogle Scholar
  49. 49.
    Tullberg T, Blomberg S, Branth B, Johnsson R. Manipulation does not alter the position of the sacroiliac joint: a roentgen stereophotogrammatic analysis. Spine 23(10):1124–1129, 1998.CrossRefPubMedGoogle Scholar
  50. 50.
    Fortin J, Dwyer A, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique: I: asymptomatic volunteers. Spine 19(13):1475–1482, 1994.PubMedGoogle Scholar
  51. 51.
    Fortin J, Dwyer A, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique: II: clinical evaluation. Spine 19:(13)1483–1489, 1994.PubMedCrossRefGoogle Scholar
  52. 52.
    Pulisetti D, Ebraheim N. CT-guided sacroiliac joint injections. J Spinal Disord 12(4):310–312, 1999.PubMedGoogle Scholar
  53. 53.
    Calvillo O, Esses S, Ponder C, D’Agostino C, Tanhui E. Neuroaugmentation in the management of sacroiliac joint pain: report of two cases. Spine 23(9):1069–1072, 1998.CrossRefPubMedGoogle Scholar
  54. 54.
    Derby R, Kine G, Saal JA, et al. Response to steroid and duration of radicular pain as predictors of surgical outcome. Spine 17:S176–S183, 1992.PubMedGoogle Scholar
  55. 55.
    Slosar PJ, White AH, Wetzel FT. Controversy. The use of selective nerve root blocks: diagnostic, therapeutic or placebo? Spine 23:2253–2256, 1998.CrossRefPubMedGoogle Scholar
  56. 56.
    North RB, Kidd DH, Zahurak M, Piantadosi S. Specificity of diagnostic nerve blocks: a prospective, randomized study of sciatica due to lumbosacral spine disease. Pain 65:77–85, 1996.CrossRefPubMedGoogle Scholar
  57. 57.
    Bonica JJ, Buckley FP. Regional analgesia with local anesthetics. In: Bonica JJ, ed. The Management of Pain. Philadelphia: Lea & Febiger; 1990:1883–1966.Google Scholar
  58. 58.
    Loeser JD. Dorsal rhizotomy for the relief of chronic pain. J Neurosurg 36: 745–754, 1972.PubMedCrossRefGoogle Scholar
  59. 59.
    Wetzel FT, Phillips F, Bernard TN, Aprill CN, LaRocca SH. Extradural sensory rhizotomy in the management of chronic lumbar radiculopathy: a minimum two-year follow-up study. Spine 22:2283–2292, 1997.CrossRefPubMedGoogle Scholar
  60. 60.
    North RB, Kidd DH, Campbell JN, Long DM. Dorsal root ganglionectomy for failed back surgery syndrome: a five-year follow-up study. J Neurosurg 74:236–242, 1991.PubMedCrossRefGoogle Scholar
  61. 61.
    Weiss S, Davis D. The significance of the afferent impulses from the skin in the mechanism of visceral pain: skin infiltration as a useful therapeutic measure. Am J Med Sci 176:517, 1928.Google Scholar
  62. 62.
    Wang JC, Brodke DS, Youssef JD. Epidural injections for the treatment of symptomatic lumbar herniated discs. J Spine Disord 15:269–272, 2002.Google Scholar
  63. 63.
    Riew KD, Yin Y, Gilula L. et al. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. J Bone Joint Surg (Am) 82:1589–1593, 2000.Google Scholar
  64. 64.
    Carette S, Leclaire R, Marcoux S, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 336:1634–1640, 1997.CrossRefPubMedGoogle Scholar
  65. 65.
    Kleinstueck F, Diederich C, Nan W, Smith JA, Puttlitz C, Lotz J, Bradford DS. The IDET procedure: thermal distribution and biomechanical effects on human lumbar disk. North American Spine Society, 15th Annual Meeting, New Orleans, October 25–28, 2000.Google Scholar
  66. 66.
    Shah RV, Lutz CE, Lee J, Doty SB, Rodeo S. Intradiscal electrothermal therapy: a preliminary histologic study. Arch Phys Med Rehabil 82:1230–1237, 2001.CrossRefPubMedGoogle Scholar
  67. 67.
    Saal JA, Saal JS. Intradiscal electrothermal treatment for chronic discogenic low back pain. a prospective outcome study with minimum 1-year followup. Spine 25(20):2622–2627, 2000.CrossRefPubMedGoogle Scholar
  68. 68.
    Saal JS, Saal JA. Management of chronic discogenic low back pain with a thermal intradiscal catheter. Spine 25(3):382–387, 2000.CrossRefPubMedGoogle Scholar
  69. 69.
    Karasek M, Bogduk N. Twelve-month follow-up of a controlled trial of intradiscal thermal annuloplasty for back pain due to internal disc disruption. Spine 25(20):2601–2607, 2000.CrossRefPubMedGoogle Scholar
  70. 70.
    Thompson K, Eckel T. IDET Nationwide Registry preliminary results: 6-month follow-up data on 170 patients. North American Spine Society, 15th Annual Meeting, New Orleans, October 25–28, 2000.Google Scholar
  71. 71.
    Pauza K, Howell S, Dreyfuss P, Peloza J, Park K. A randomized double-blinded placebo-controlled trial evaluating the efficacy of intradiscal electrothermal annuloplasty (IDET) for the treatment of chronic discogenic low back pain: 6-month outcome. International Spinal Injection Society, 10th Annual Meeting, Houston, TX, September 7, 2002.Google Scholar
  72. 72.
    Wetzel FT, Anderson GBJ, Peloza J, Rashbaum R, Lee CR, Yuan HK, Phillips FM, An HS. Intradiscal electrothermal therapy (IDET) to treat discogenic low back pain: preliminary results of a multi-center prospective cohort study. North American Spine Society, 15th Annual Meeting, New Orleans, October 25–28, 2000.Google Scholar
  73. 73.
    Iqbal MM, Sobhan T. Osteoporosis: a review. Mod Med 99:19–24, 2002.Google Scholar
  74. 74.
    Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q 67:450–484, 1989.PubMedGoogle Scholar
  75. 75.
    Johnell O. Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality. J Intern Med 239:299–304, 1996.CrossRefPubMedGoogle Scholar
  76. 76.
    Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168, 1987.PubMedGoogle Scholar
  77. 77.
    Cortet B, Cotton A, Boutry N, et al. Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26:2222–2228, 1999.PubMedGoogle Scholar
  78. 78.
    Cyteval C, Sarrabere MP, Roux JO, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 Patients. AJR Am J Roentgenol 173:1685–1690, 1999.PubMedGoogle Scholar
  79. 79.
    Deramond H, Depriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36:533–546, 1998.CrossRefPubMedGoogle Scholar
  80. 80.
    Gangi A, Kastler BA, Dietemann JL. Percutaneous vertebroplasty guided by a combination of CT and fluoroscopy. AJNR Am J Neuroradiol 15: 83–86, 1994.PubMedGoogle Scholar
  81. 81.
    Grados F, Depriester C, Cayrolle G, et al. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414, 2000.CrossRefGoogle Scholar
  82. 82.
    Mathis JM, Petri M, Naff N. Percutaneous vertebroplasty treatment of steroid-induced osteoporotic compression fractures. Arthritis Rheum 41:171–175, 1998.CrossRefPubMedGoogle Scholar
  83. 83.
    Hardouin P, Grados F, Cotton A, et al. Should percutaneous vertebroplasty be used to treat osteoporotic fractures? An update. Joint Bone Spine 68:216–221, 2001.CrossRefPubMedGoogle Scholar
  84. 84.
    Padovani B, Kasriel O, Brunner P, et al. Pulmonary embolism caused by acrylic cement: a rare complication of percutaneous vertebroplasty. AJNR Am J Neuroradiol 20:375–377, 1999.PubMedGoogle Scholar
  85. 85.
    Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporosis Int 12:429–437, 2001.CrossRefGoogle Scholar
  86. 86.
    Wong W, Reiley MA, Garfin S. Vertebroplasty/Kyphoplasty. J Women’s Imag 2:117–124, 2000.Google Scholar
  87. 87.
    Belkoff SM, Mathis JM, Fenton DC, et al. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine 26:151–156, 2001.CrossRefPubMedGoogle Scholar
  88. 88.
    Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515, 2001.CrossRefPubMedGoogle Scholar
  89. 89.
    Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638, 2001.CrossRefPubMedGoogle Scholar
  90. 90.
    Phillips FM, McNally T, Wetzel FT, et al. Early clinical and radiographic results of kyphoplasty for the treatment of osteopenic vertebral compression fractures. Eur Spine J 10:(suppl 1)S7, 2001.Google Scholar
  91. 91.
    Garfin S, Lin G, Lieberman I, et al. Retrospective analysis of the outcomes of balloon kyphoplasty to treat vertebral body compression fracture (VCF) refractory to medical management. Eur Spine J 10 (suppl 1):S7, 2001.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 2004

Authors and Affiliations

  • F. Todd Wetzel
  • Frank M. Phillips

There are no affiliations available

Personalised recommendations