2. Treatment goals of treatment relieve pain, prevent or reduce stress on the discs, and maintain normal function ranges from conservative therapies to surgical interventions

3. Conservative Treatment Most treatment plans involve a combination of self- administered treatments, medications, and therapeutic measures. Self-administered treatments include the following: – Learn/practice proper posture and body mechanics – Rest and restrict activities – Limited bed rest to take pressure off the spine – Mild activity (exercise) such as walking, biking, and swimming – Apply cold and/or hot packs – Wear a brace for support (may not be helpful in all cases)

4. Conservative Treatment Therapeutic treatments for DDD include the following: – Chiropractic treatment to manipulate the spine – Acupuncture to relieve pain – Massage therapy to relieve muscle spasms and tension – Physical therapy to improve function and increase flexibility and strength

5. Medications Are used to supplement conservative therapy. – Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., aspirin, ibuprofen, naproxen) – Pain relievers (e.g., acetaminophen) – Muscle relaxants – Spinal injections (anesthetics or corticosteroids) – Antidepressants – Sleep aids Other non-surgical treatments – ultrasound therapy : uses sound waves to warm the area, increase blood flow, and relieve discomfort – transcutaneous electrical nerve stimulation (TENS): uses electrical stimulation of the nerve to interrupt pain signals

6. Surgical Primary reasons for surgery are to: – relieve pressure on a nerve root or the spinal cord – stabilize an unstable or painful vertebral segment – prevent or limit radiculopathy (nerve damage) – reduce deformity or curvature of the spine (e.g., scoliosis)

7. Surgical Discectomy and fusion – involves removing the damaged intervertebral disc and replacing it with a piece of bone or another material – this replacement fuses with the adjacent vertebrae Corpectomy – a section of the vertebrae and discs is removed to create more space for the remainder of the spine – A bone graft and/or metal plate with screws – attached to stabilize the spine Facetectomy, laminotomy, and spinal laminectomy – procedures that involve removing a portion of the bony structure of the spine to relieve pressure on the nerve roots – Foraminotomy and laminoplasty can be used to enlarge areas of the spinal column to make more room for the nerves and spinal cord

8. Surgical Micro-discectomy –removes a disc through a very small incision using a microscope. Percutaneous disc decompression –reduces or eliminates a small portion of the bulging disc through a needle inserted into the disc, minimally invasive Spinal decompression –A non-invasive procedure that enlarges the Intra Vertebral Foramen (IVF) by aiding in the rehydration of the spinal discs. Spinal laminectomy –relieves pressure of spinal stenosis –part of the lamina is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

9. Indications for Surgery

10. Surgery may be recommended: 1.If the conservative treatment options do not provide relief within two to three months. 2.If leg or back pain limits normal activity 3.If there is weakness or numbness in the legs 4.If it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary, most often spinal fusion.

11. Lumbar surgery – indicated in patients with severe spinal stenosis, in those with intractable pain, and in patients in whom an appropriate 6- to 12-month nonoperative course of treatment fails. In elective cases, other conservative modalities should have been tried and observed to fail. In cases of cervical disk disease with radiculopathy – indications for surgical treatment are intractable pain, progressive motor or sensory deficit, or symptoms refractory in a reasonable period of nonoperative therapy In cases of cervical disk disease with myelopathy – early surgery to decompress the spinal cord is recommended to arrest progression if the clinical and radiographic changes are well correlated

12. References: – http://www.cedars-sinai.edu/515.html http://www.cedars-sinai.edu/515.html – http://www.cedars-sinai.edu/889.html http://www.cedars-sinai.edu/889.html – http://www.cedars-sinai.edu/5757.html http://www.cedars-sinai.edu/5757.html – http://www.neurologychannel.com/degenerative-disc- disease/treatment.shtml http://www.neurologychannel.com/degenerative-disc- disease/treatment.shtml – http://www.dcmsonline.org/jax- medicine/1999journals/april99/degenerative.htm http://www.dcmsonline.org/jax- medicine/1999journals/april99/degenerative.htm – http://emedicine.medscape.com/article/1265453- treatment http://emedicine.medscape.com/article/1265453- treatment