Disability Following Causally Related Lumbar Disc Surgery

Disability Following Causally Related Lumbar Disc Surgery

Traumatic bodily injuries can produce profound functional limitations on the body. These injuries may ultimately require surgical intervention to stabilize the progression of the injury. Surgery is not to be entered into lightly and often there is a misconception that the surgical procedure will “cure” the trauma victim and will return the patient to the normal life he/she had prior to the injury. There are a myriad of points to consider including surgical complications, permanent changes in the biomechanics (particularly in the spine) of the injured area and need for rehabilitation.

Although they are all important, permanent changes in the biomechanics resulting in secondary syndromes and the risk of the patient suffering from a NEW injury resulting from the surgery must be documented. This is critically important since there are costs associated with treatment of those syndromes. In a recent article by Steib et al. (2012) published in the Journal of Neuroscience, the authors stated, “Postoperative facet syndrome (pFJS) requiring intervention is a common problem following lumbar disc surgery (LDS)” (p. 418). They go on to write, “The prevalence of pFJS [postoperative facet syndrome] in patients after lumbar intervention is between 8% and 32%” (Steib et al., 2012, p. 418). They also point out, “...4% to 10% of LDH [lumbar disc herniations] reoccur after surgical removal with a follow-up of 10 years" (Steib et al., 2012, p. 421). The authors concluded, “We assume that the recurrent prolapse [herniation], which requires a second surgical decompression early after the initial procedure, complicates the postsurgical pain and hinders the healing process. Furthermore, the required reintervention represents an additional trauma as the disc is removed more extensively. This potentially leads to a progressive constraint on the facet joints and promotes spinal instability” (Steib et al., 2012, p. 421).

When caring for the traumatically injured, we know it is critical to understand and document the LIFETIME CONSEQUENCES OF CAUSALLY RELATED TREATMENT.

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Reference:

Steib, K., Proescholdt, M., Brawanski, A., Lange, M., Schlaier, J., & Schebesch, K. M.(2012). Predictors of facet joint syndrome after lumbar disc surgery. Journal of Clinical Neuroscience, 19(3), 418–422.