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

THERAPEUTIC EXERCISE

• McKenzie method– Extension exercises– Focuses on the muscles and ligaments– Maintains the spine’s natural lordotic curve,

important to good posture

THERAPEUTIC EXERCISE

• Aerobics – 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

PHARMACOLOGIC TREATMENT

• Peripherally acting analgesics – Acetaminophen• For mild to moderate pain• Inhibits inflammatory reactions and pain by decreasing

prostaglandin synthesis.

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

• 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