Revision surgery in lumbar degenerative disease

Introduction: Lumbar degenerative disease is a common health problem all over the world and the need for revision surgery is still high with variable results. The aim of the work: Is to evaluate the clinical and radiologic outcome in cases of redo surgery for lumbar degenerative pathology and to specify which pathology is responding well to revision surgery.Patients and methods: Forty eight patients were operated upon for revision of previous failed back surgery in Zagazig University Hospitals from August 2014 to April 2017. Selection of patients for revision surgery depends on confirmed radiological and clinical compression or instability. All patients were operated and followed for at least 6 months after surgery. VAS score was used as a tool for evaluation of back and leg pain.Results: There were 48 patients; with a mean age of 46.7 years (range 22-78).There were 29 males and 19 females. The dominant symptoms were unilateral sciatica in 30, bilateral in 11, low back pain in 23 patients.Neurogenic claudication was present in 4 cases. Type of surgery was redo discectomy in 31 cases, revision decompression for spinal canal stenosis in 4 cases, and posterior lumbar interbody fusion in 13 cases, with success rate of 96.8%, 75% and 84.6% respectively regarding improvement after surgery.Conclusion: Revision surgery of lumbar degenerative diseases gives excellent results provided that the patients are properly selected

Lumbar facet joint block: computed tomography guided technique compared with fluoroscopy guided technique using the posterior approach: a comparative study

Facet joint is a main source of chronic low back pain with a prevalence of 16.7%. Clinical examination and imaging are insufficient to diagnose facet joint syndrome [30% accuracy and 45% false positives]. Facet joint block is the gold standard in diagnosis of facet joint syndrome. It can also relieve pain for up to 6 months. It can be done under computed tomography [CT] or fluoroscopy. To identify which imaging modality is more suitable to guide the procedure of lumbar facet joint block, fluoroscopy or CT. Thirty four lumbar facet joints represented by 12 patients were injected in the radiology department, Suez Canal University Hospital, Ismailia, Egypt from 1/2005 to 1/2006. All cases were suspected of having facet joint syndrome based on clinical or radiological data. After clinical examination and reviewing lumbar images to identify target facets, every patient underwent facet joint block under either CT or fluoroscopy. Fluoroscopy was more successful in guiding the injections [success rate 77.7% compared with 31.25% in CT guidance]. It is also faster [6.6 minutes per joint compared with 10.9 minutes for CT guidance]. Less number of trials were required [1.7 trial compared with 6.6 trials with CT guidance]. Fluoroscopy exposed the patients and the radiologist to much irradiation [21.3 rad compared to 0.3 rad in CT guidance]. Decreased bone density and laminectomy impair fluoroscopy guidance. CT guidance is difficult in patients with marked arthropathy and coronally oriented joints [8 trials compared with 5.6 for normally appearing joints]. Fluoroscopy should be the primary choice for guiding lumbar facet joint block. It is more successful and faster. Its disadvantages include much irradiation to patients and radiologists, and difficulty in patients with laminectomy and decreased bone density. CT can then be used to guide the block

Criteria for diagnosis of lumbar spinal canal stenosis

Anatomical and radiological measurements of anteroposterior and interpediculate diameters of lumbar spinal canal was carried out on 50 cadaveric specimens and 100 plain X-ray films. Studying the configuration of the canal was possible by plotting curves of anteroposterior diameters versus interpedicular diameters and the reverse. Such curves correlate both dimensions to each other. Measurements not coinciding with the lower normal dimensional limits of the curves or not correlated with each other were taken as an indication of stenotic lumbar spinal canal