Transcript 5. How does one treat a degenerative spine disease? What are the

5. How does one treat a
degenerative spine disease? What
are the indications for surgery?
PHYSICAL THERAPY
• Relative rest for up to the first 2 days after an
acute episode
– restricts all occupational and avocational activities
• Do not rest for longer periods
– can cause deconditioning, loss of bone density,
decreased intradiscal nutrition, loss of muscle
strength and flexibility, and increased segmental
stiffness
PHYSICAL THERAPY
• Passive modalities (application of heat to the
tissues)
– valuable during the initial 48 hours of relative rest
to aid in pain relief
• Manual techniques (massage, mobilization)
– increase soft tissue pliability when secondary
myofascial tightness is present
PHYSICAL THERAPY
• Dynamic lumbar-spine stabilization programs
– Maintain a neutral spine position throughout
various daily activities
– This position allows for balanced segmental force
distribution between the disk and zygapophyseal
joints
– provides functional stability with axial loading to
help minimize the chance for acute dynamic
overload upon the disks
– minimizes tension on ligaments and fascia planes
THERAPEUTIC EXERCISE
• The pain response may limit flexibility
• Stretching exercises
– improve flexibility of the trunk muscles
• Flexion exercises
– Widen the intervertebral foramen
THERAPEUTIC EXERCISE
• McKenzie method
– Extension exercises
– Focuses on the muscles and ligaments
– Maintains the spine’s natural lordotic curve,
important to good posture
THERAPEUTIC EXERCISE
• Aerobics
– Improved muscular endurance, coordination,
strength, strong abdominal muscles, and weight
loss
• Strong abdominal muscles
– Reduce the loads to the lumbar spine
• Walking, bicycling, and swimming
PHARMACOLOGIC TREATMENT
• Peripherally acting analgesics
– Acetaminophen
• For mild to moderate pain
• Inhibits inflammatory reactions and pain by decreasing
prostaglandin synthesis.
PHARMACOLOGIC TREATMENT
• Peripherally acting analgesics
– Nonsteroidal anti-inflammatory drugs (NSAIDs)
• the drugs of choice in initial pharmacologic treatment
of acute episodes of diskogenic pain or with acute
exacerbation of chronic diskogenic pain
• MOA: inhibition of cyclo-oxygenase, competition with
prostaglandin at receptor sites, and inhibition of WBC
migration and of lysosomal enzymes from WBCs
SURGICAL INTERVENTION
• Indications
– Conservative treatment options do not provide
relief within 2 to 3 months
– Nonoperative medical management fails to
adequately relieve the intolerable pain during ADL
– Progressive neurologic deterioration (numbness
or muscle weakness)
– Documented compression of the nerve root,
spinal cord, or both
SURGICAL INTERVENTION
• Decompression
– removal of bone or disk material from around a
compressed nerve root
– to relieve pinching of the nerves
– provide more room for their recovery
– performed through laminectomy and diskectomy
SURGICAL INTERVENTION
• Spinal fusion
– uses a bone graft to fuse one or more vertebrae
– stop motion at a painful vertebral segment
– stop or decrease the pain generated from the joint
SURGICAL INTERVENTION
• Surgical approach
– anterior, posterior, or combined procedure
– interbody fusion with allograft autologous bone or
threaded titanium cage
– intertransverse process in situ fusion with or
without instrumentation