Degenerative disc disease - Treatment

Pharmacological Therapy
Medications are an integral part of treatment. There are a variety of medications prescribed to help patients with sequelae. Several types of drugs are helpful in treating pain discogenice: analgesics, muscle relaxants, sedatives, corticosteroids, anticonvulsants, antidepressants, antihistamines.
NSAIDs are based therapy. They are effective by reducing the biological effects of inflammation and pain. Their management should be monitored for adverse effects and gastropathy, renal toxicity, hypertension, liver disorders and hemorrhage.Treatment is by nature conservative. Regimens are most commonly used NSAIDs, physical therapy and lifestyle changes.Lumbar spine immobilization is the standard conservative therapy for these patients. Immobilization restricts motion and reduce nerve irritation.
Tricyclic antidepressants are indicated for patients who experience chronic pain. Common side effects include dry mouth, sedation, urinary retention, constipation, cardiac conduction block.
Muscle relaxants such as carisoprodol and ciclobenzapina are beneficial in patients with spasm of the lumbar muscles. Opioids are indicated in patients with moderate to severe pain with significant structural degeneration, which are not candidates for surgery and those who have failed therapy with other agents. For those at risk from NSAID gastropathy, especially opioids are reasonable grounds geriatric population.
Steroids.In some patients with significant radiculopathy a high dose of steroids to reduce pain and shorten the symptoms. Some patients with progressive degenerative myelopathy shows the benefits as well. Epidural steroid injections help patients with radicular symptoms. Patients experiencing acute injury caused by osteophites ventral medullary benefit of high dose methylprednisolone.
Physical Therapy
It remains a conservative standard in the treatment of chronic low back pain, including aerobic exercise, muscle stretching.Significant variation in the intensity and frequency of exercise depends on the condition pacidentului.
Transcutaneous electrical nerve stimulationIt is a therapeutic technique involving the application of electrodes, which releases a cutaneous peripheral nerve electrical stimulation for noninvasive pain relief. Such devices are available regimens at home.
Lumbar SupportBenefit patients suffering from chronic back pain secondary degenerative processes. They restrict movement of the spine, stabilize, correct deformities and reduce the mechanical forces.They massage the affected areas and the effects of local heat application.
Lumbar TractionThis applies an axial force longitufinala column using a harness attached to the iliac crest and lower ribs to relieve chronic back pain. These forces widen the intervertebral space and correct the lordosis.
Surgical TherapySurgery is occasionally performed. Many therapeutic modalities for degenerative disc disease have not been studied yet. Surgery is indicated for patients with lumbar radiculopathy with persistent pain, weakness, or progressive symptoms that do not improve with physical therapy.
Chemonucleoliza with chimopapaina or collagenaseChemolitice substance is administered in the affected intervertebral disc. Due to the risk of anaphylaxis indicate cardiopulmonary monitoring.
Automated percutaneous lumbar DisectomiaThis procedure is safer than the injections Intradisc chemopapainei input. Allows removal of the central disc material by placing a suction needle and automated.
Arthroscopic MiodiscectomiaIn this technique the surgeon visualize the lumbar nerve roots and fibrous ring of the disc printrun endoscope. Fragments of the posterior disc can be removed by manual or automated instrumentation. The technique is especially recommended incarcerated herniated disc when noninvasive methods have failed.
Anuloplastia electrothermical IntradiscMiniminvaziva is a surgical technique. After intervertebral disc is approached by fluoroscopic guidance a catheter is inserted into the ring posterior disc electrodermal painful. Candidates for this technique are patients with back pain caused by a small hernia, internal cracks easy disc or disc degeneration limited to two levels.It is done after conservative treatment for six months failed. It is a safe procedure with a low rate of complications. disc infection occurs in less than 1% of patients.
Artificial DiscsThe main objective of the artificial disc is painful to drive inlocuieasca maintaining natural anatomical structure of the column. Flexicore Charité disks or are used. The indications for implantation of an artificial disc are similar to those for spinal fusion and degenerative disc disease include limited to a single level, 18-60 years old, severe back pain, conservative treatment for at least six months.The two types of artificial discs are:Total disc prosthesis, which replaces the complete intervertebral discNuclear-prosthesis which replaces the soft middle of the disc nucleus.Artificial disc has a metal shell and a core of polyethylene.