Use of the pantaloon cast for the selection of fusion candidates in the treatment of chronic low back pain.

Forty-five patients with low back pain (LBP) of longer than six months' duration and for whom all conservative therapies failed were placed in a pantaloon cast for a two- to four-week trial period. Significant pain relief occurred in 31 (69%) of these patients. Of these 31, 23 patients were treated with spinal arthrodesis using lateral, intertransverse process fusions with iliac bone grafts. Before fusion, the painful lumbar segments were determined by facet analgesic blocks or the normal saline acceptance test. After an average follow-up period of 14 months, 17 (74%) had significant pain relief. The pantaloon cast may be an effective tool for identifying those chronic LBP patients who might benefit from spinal stabilization procedure.