Conservative treatment
In most cases degenerative disc disease can be managed with
conservative (non-surgical) treatments. Patients with this condition
tend to experience pain that occasionally intensifies, but as long
as the pain is manageable overall surgery can usually be avoided. A
consistent exercise program can help maintain stability in the
problem area, so the excess movement and pain are lessened.
Exercises that can be helpful include
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hamstring stretching
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dynamic lumbar stabilization exercises
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low-impact aerobic conditioning
Patients should consider visiting a physical therapist to learn
how to do these types of exercises safely and effectively.
Non-prescription medications, such as ibuprofen (e.g. Advil, Nuprin,
Motrin) to reduce inflammation, and acetaminophen (e.g. Tylenol) for
its analgesic (pain-relieving) qualities, may be helpful in
alleviating lower back pain. Stronger therapies, such as oral
steroids or epidural steroid injections, may be prescribed to treat
severe flare-ups of pain if needed.
Surgical treatment
In more serious cases, patients may be in severe pain and may be
unable to function due to the pain. In such cases, lumbar fusion
surgery is an option. A spinal fusion surgery is designed to stop
the motion at a painful vertebral segment, which in turn should
decrease pain generated from the joint. All lumbar fusion surgery
involves adding bone graft to an area of the spine to set up a
biological response that causes the bone graft to grow (fuse) and
thereby stop the motion at that segment.
A spine fusion surgery involves using bone
graft to cause two vertebral bodies to grow together into one long
bone. Bone graft can be taken from the patient’s hip (autograft
bone) during the fusion surgery, or harvested from cadaver bone
(allograft bone). Synthetic bone graft substitutes are also in
development, and one type—bone morphogenic proteins (which helps the
body create bone)—is currently being used for certain fusion
procedures.
In general, a lumbar spinal fusion is most effective for treating
only one vertebral segment. Most patients will not notice any
limitation in motion after a one-level fusion. When necessary,
fusing two segments of the spine may be a reasonable option for
treatment of pain. However, spinal fusion of more than two segments
is unlikely to provide pain relief because it removes too much of
the normal motion in the back and places too much stress across the
remaining joints.
This option should only be considered after conservative treatment
has been proven to be ineffective, and if the patient is truly
limited by the degree of pain they experience. Some alternatives to
fusion that are currently available or being researched, including
IDET, artificial discs (in clinical trials in the US), and disc
regeneration (currently being researched). |
