5. How does one treat a degenerative spine disease 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 In some patients, the pain response may limit flexibility. Prescribed stretching exercises can improve flexibility of the trunk muscles. Flexion exercises may help to widen the intervertebral foramen. The intervertebral (between the vertebrae) foramen are small canals through which the nerve roots exit the spinal cord. The intervertebral foramen are located on the left and right sides of the spinal column.

THERAPEUTIC EXERCISE McKenzie method Extension exercises Focuses on the muscles and ligaments Maintains the spine’s natural lordotic curve, important to good posture Extension exercises, such as the McKenzie method, focuses on the muscles and ligaments. These exercises help maintain the spine’s natural lordotic curve, important to good posture.

THERAPEUTIC EXERCISE Aerobics Strong abdominal muscles 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 Aerobics (no/low impact) offers many benefits including improved muscular endurance, coordination, strength, strong abdominal muscles, and weight loss. Strong abdominal muscles work like a brace (or corset) to reduce the loads to the lumbar spine. It is also known that aerobics help to combat anxiety and depression. The loads on the discs during walking are only slightly greater than when lying down. Walking, bicycling, and swimming are forms of aerobic exercise a physician may suggest.

PHARMACOLOGIC TREATMENT Peripherally acting analgesics Acetaminophen For mild to moderate pain Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Several types of medications may be helpful in treatment of diskogenic pain (eg. analgesics [peripheral and centrally acting], muscle relaxants, sedatives, or glucocorticoids)

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 is an option when nonoperative medical management fails to adequately relieve the intolerable pain during activities of daily living which is individual-specific. It should also be considered in patients with initial signs and symptoms of progressive neurologic deterioration, specifically numbness or muscle weakness.

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