5. How does one treat a degenerative spine disease? What are the indications for surgery?

Rehabilitation Program 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 intradiskal nutrition, loss of muscle strength and flexibility, and increased segmental stiffness 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 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

Rehabilitation Program Occupational Therapy adjunct in the rehabilitation process when generalized muscular deconditioning has created adverse effects on strength, endurance, and flexibility of the upper extremities and/or impairment in ADL ensures proper ergonomics at the work site, which may involve simply reconfiguring a desktop and/or workstation, or it may require complex solutions. Rehabilitation before the patient resumes full-time duties. – After the offending source of pain is resolved, the patient typically has deconditioning and may require activity-specific reconditioning to prevent new or recurring injury.

Pharmacologic Treatment Several types of medications may be helpful in treatment of diskogenic pain (eg. analgesics [peripheral and centrally acting], muscle relaxants, sedatives, or glucocorticoids) Peripherally acting analgesics – Acetaminophen For mild to moderate pain Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. – 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 – progressive neurologic deficits – documented compression of the nerve root, spinal cord, or both – Intractable pain – conservative treatment options do not provide relief within 2 to 3 months

Surgical Intervention Decompression – removal of bone or disk material from around a compressed nerve root to relieve pinching of the nerves and provide more room for their recovery – performed through laminectomy and diskectomy Spinal fusion – uses a bone graft to fuse one or more vertebrae and stop motion at a painful vertebral segment – stop or decrease the pain generated from the joint 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