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Lumbar Degenerative Disc Disease |
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Treatment Options
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For most people, degenerative disc disease can be successfully treated with conservative
(meaning non-surgical) care consisting of medication to control inflammation and
pain (either oral or injection), and physical therapy and exercise. Surgery is only
considered when patients have not achieved relief over six months of conservative
care and/or are significantly constrained in performing everyday activities.
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Non-surgical treatment for degenerative disc disease
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The ongoing pain, as well as the frequency and intensity of the flares, can be mitigated
through a number of non-surgical options. Modifying activities to preclude lifting
of heavy objects and playing sports that require rotating the back (e.g. golf, basketball
or football) can be a good first step. Other options include:
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Applying heat to stiff muscles or joints to increase flexibility and range of motion,
or using ice packs to cool down sore muscles or numb the area where painful flares
are concentrated.
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Medications such as non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen,
COX-2 inhibitors) and pain relievers like acetaminophen (such as Tylenol) help many
patients feel good enough to engage in regular activities. Stronger prescription
medications such as oral steroids, muscle relaxants or narcotic pain medications
may also be used to manage intense pain episodes on a short-term basis, and some
patients may benefit from an epidural steroid injection. Not all medications are
right for all patients, and patients will need to discuss side effects and possible
factors that would preclude taking them with their physician. |
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An exercise program is essential to relieving the pain of lumbar degenerative disc
disease and should have several components, including |
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Hamstring stretching, since tightness in these muscles can increase the stress on
the back and the pain caused by a degenerative disc. |
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A strengthening exercise program, such as Dynamic Lumbar Stabilization exercises,
where patients are taught to find their ‘natural spine’, the position in which they
feel most comfortable, and to maintain that position |
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Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate
flow of nutrients and blood to spine structures, and relieve pressure on the discs.
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Chiropractic manipulation can relieve low back pain by taking pressure off sensitive
nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle
tension, and, like more active exercise, promoting the release of endorphins within
the body to act as natural painkillers. |
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Epidural steroid injections can provide low back pain relief by delivering medication
directly to the painful area to decrease inflammation. |
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Surgery for degenerative disc disease |
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Patients unable to function because of the pain or who are frustrated with their
activity limitations may consider lumbar spinal fusion surgery. Fusion surgery works
because it stops the motion at a painful motion segment. A one-level fusion at the
L5-S1 segment does not significantly change the mechanics in the back and is the
most common form of fusion, as this is the most likely level to break down for degenerative
disc disease. |
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Fusion of the L4-L5 level does remove some of the normal motion of the spine as
this is a major motion segment (as opposed to L5-S1 which has really limited motion)
Multi-level fusions are more problematic. A two-level fusion may be considered for
patients with severe, disabling pain, but three-level fusions are not recommended
because back movement is too diminished and altering the muscle composition can
in and of itself cause pain. |
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While it is a major surgery, fusion surgery can be an effective option for patients
to enhance their activity level and overall quality of life. This is particularly
true now that minimally invasive techniques are available to decrease post-operative
discomfort, preserve more of the normal anatomy of the low back, and result in higher
rates of fusion than previous techniques. |
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A newer surgery to treat pain and disability from lumbar degenerative disc disease
is artificial disc replacement. The theory is that replacing the disc, instead of
fusing the disc space together, maintains more of the normal motion in the lumbar
spine, thereby reducing the chance that adjacent levels of the spine will break
down due to increased stress. This procedure is still a new procedure in the US,
so long-term efficacy, and potential risks and complications are still relatively
unknown.
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