Injuries and Conditions: Degenerative Disc Disease : Degenerative Disc Disease :
The treatment plan chosen, is dependent on the severity of the symptoms experienced by the patient. Only after a physician has made a complete review of all diagnostic findings, can a course of treatment be formulated. The pain and discomfort experienced can vary widely from patient to patient and treatment is dependent upon the severity of the condition and the intensity of the symptoms.
Depending on the symptoms the patient experiences, different surgical procedures are used. In cases where pain is generated from the degenrated disc only, a spinal fusion may be recommended. There are many surgical options to accomplish fusion. The spine may be appoached anteriorly (Anterior Lumbar Interbody Fusion or ALIF), posteriorly (Posterior Lumbar Interbody Fusion or PLIF, or in a combined approach A posterolateral fusion with or without instrumentaion may also be selected.
Your surgeon will use his experience, knowledge, and judgement and decide whether metallic implants (instrumentation) should be used. Metalic implants are placed across the fusion area to minimize motion while the bones heal into a fusion mass. Types of bone grafts will also be discussed with the patient.
The theory behind the surgical of spinal fusion is to remove the disc that generates the pain and fuse that specific segment of the spine. Most patients will loose only minimal motion since the other normal vertebrae and discs surrounding the fusion will compensate for the loss of motions in the fused segment. In cases where the degenerative disc reduces the size of the spinal canal and places presure on the nerves, the spinal surgeon may choose to decompress the narrwoing canal. Lamina, bone spurs, protruding or herniating discs that are reducing the size of the spinal canal and compressing the spinal caord and nerve root are removed. After decompression of the canal, more space will be available for the neural tissues. Depending on the amount of bone removed necessary to decompress the neural tissues, that spine segment may be judged to be at risk for development of deformity. If the spinal surgeon predicts that you may be at risk for instabillity, he or she will choose to place bone graft at the sides of the bony spine to fuse that segmnet and prevent instability.
The purpose of this surgery is to relieve the pain and symptoms associated with the narrowing of the spinal canal that has resulted from the degeneration of the intervertebral disc and the surrounding structures of the spinal column. Lamina, bone spurs, protruding or herniating discs that are reducing the size of the spinal canal and compressing the spinal cord and nerve root are removed.
Patients undergo a complete history and physical examination in addition to specific diagnostic imaging studies to determine the severity and level of the degenerative disc disease.
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, although the after-effects of anesthesia can vary greatly from patient to patient.
Post-operative pain will be controlled through the administration of analgesics (painkillers).
Patients are up and walking the same night or the next morning following surgery.
A critical part of a successful recovery from surgery for degenerative disc disease involves the active participation in a rehabilitation program. Increasing the muscle strength of the back in a non-impact loading manner (e.g. swimming) is the most recommended types of exercise.
Recovery is dependent upon the degree of degeneration present at the level of each disc and the degree of compression pressure affecting the nerve roots and spinal cord at that level.
Patient's goals and lifestyle may need to be altered, with modification of activities that increase symptoms.
Risks during and after surgery include problems that may develop in relation to bleeding, infection, and/or anesthesia.
Injury to blood vessels and nerves.
The possibility of developing unforeseen complications.
Additional degenerative or arthritic changes in the future.
Rest following an acute episode of pain.
Medications including NSAIDs (non-steroidal anti-inflammatory drugs) may bring relief.
Epidural steroid injections may be useful in relieving the pain associated with nerve irritation or compression.
Postural changes may relieve symptoms. These include leaning forward while walking or lying down with the knees drawn up to the chest. Both enlarge the space available for the nerve root to go through. This is most effective if spinal stenosis has resulted from the degenerative disc disease.
Physical therapy can strengthen and help maintain flexibility of the muscles supporting the spine.
Weight loss, if over weight, to relieve pressure on the spine.
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
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Recovery is dependent upon the degree of degeneration present at the level of each disc and the degree of compression pressure affecting the nerve roots and spinal cord at that level.
Patient's goals and lifestyle may need to be altered, with modification of activities that increase symptoms.
Although uncommon, nerve root injury can result in partial paralysis and loss of feeling in the arms or legs, or loss of bowel and bladder control if specific levels of the lumbar nerves and spinal cord are involved.
The possibility of unforeseen complications
The use of NSAIDs may cause gastric or stomach irritation.
Medical and anesthesia complication due to heart and lung disease.
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