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

  • F. Todd Wetzel


The indications for surgical management of compressive syndromes such as herniated nucleus pulposus with radiculopathy and lumbar spinal stenosis with neuroclaudication are clear, and outcomes are predictable. For example, in the case of a herniated nucleus pulposus with unilateral radiculopathy, assuming strict concordance between the patient’s clinical presentation and imaging findings, the likelihood of successful outcome is 90-100% following laminotomy discectomy.1 Likewise, the addition of arthrodesis to treat degenerative spondylolisthesis in the setting of stenosis with neuroclaudication has been shown to be the treatment of choice, based on randomized prospective data.2 Outcome data for surgical treatment of low back pain (LBP) per se in the absence of neural compression and referred extremity pain is, however, less promising.3 , 4 Lumbar discography, for example, has been cited as a reasonable diagnostic technique to identify painful segments and treat them by arthrodesis.3 Not only have the sensitivity and specificity of the diagnostic technique been criticized,5 - 7 but the surgical treatment itself - arthrodesis - has been studied in only two randomized, prospective studies to date.8 , 9


Lumbar Spinal Stenosis Vertebral Compression Fracture Iliac Crest Bone Graft Epidural Steroid Injection 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.


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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • F. Todd Wetzel
    • 1
  1. 1.Department of Orthopedic SurgeryTemple UniversityPhiladelphiaUSA

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