The painful mechanical instability of the lumbar spine associated with spondylolisthesis and degenerative disk disease is difficult to manage. Patients experience symptoms associated with compression of the nerve roots and cauda equina. Back pain is usually the primary complaint making it important to differentiate the pain from that caused by musculo-ligamentous strain. It is for this reason that we stress the importance of extensive conservative therapy before considering surgical intervention. Plain x-ray flexion / extension films may demonstrate movement of one vertebral body over the other as well as reduced disk space height (fig. 1). A positive diskogram, where injection of radiopaque dye into the affected disk reproduces the patients pain and outlines a fissured or ruptured disk, localizes the level of involvement and is helpful in some cases. While compression may be caused in part by herniation of the disk, diskectomy alone is not effective in providing relief since additional impingement is produced by the reduction in disk space height and abnormal amount of movement allowed by the joint. When conservative management has failed, surgical alternatives include Anterior or Posterior Lumbar Interbody Fusion (ALIF OR PLIF), Transforaminal Lumbar Interbody Fusion (TLIF) or Disk Replacement. For information on these procedures, click on the appropriate picture to the right. |
