low back pain and lumbar disc disease john m. blair, md puget sound spine institute
TRANSCRIPT
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Low Back Pain and
Lumbar Disc Disease
John M. Blair, MD
Puget Sound Spine Institute
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Low Back Pain
Incidence:60-90% Lifetime prevalence5% Annual incidence1:1 Female/Male ratio except after age 60
Sciatica:40% Lifetime prevalence10% of patients with low back pain
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Low Back Pain Natural History
• 33% Pain free after one week• 75% Pain free after one month• >90% Pain free after three
months
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Low Back Pain
Acute Low Back Pain:
•Pain in the low back which lasts less than 90 days
Chronic Low Back Pain:
•Pain in the low back which exceeds 6 months duration•3-5% of all back pain
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Acute Low Back PainInitial Management
• Mechanical vs. Non-mechanical
• X-rays
• Exam
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Acute Low Back PainManagement
• Bed rest (2-7 days)• Early mobilization• Anti-inflamatories, muscle relaxants and
narcotics • Ice• Bracing
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Acute Low Back PainManagement
• Physical Therapy
• Spinal manipulation: May speed recovery but no long term efficacy.
• Massage Therapy: Feels good but unproven.
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DRX 9000
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DRX 9000
• There is no published literature in peer reviewed journals which supports or refutes the efficacy of this device.
• Traction has been shown to be effective in the treatment of some spinal conditions.
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Chronic Low Back PainLong-term management and
treatment
• Determine source of symptoms
• Treatment
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Low Back Pain
Determine source of symptoms:• Lumbar disk• Facet joint• Spinal nerves• Vertebral body• Soft tissues• Hip or sacroiliac joint
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Low Back Pain Diagnostic Tests
• X-Rays• MRI• CAT scan +/- myelogram• Discogram• EMG• Bone scan• Injections
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Low Back PainLong-Term Management
• Therapy/Conditioning
• Lifestyle changes
• Medication
• Injections
• Surgery
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Low Back PainLong-Term Management
The goal of long-term management is to reduce stress and strain on the back by strengthening the muscles surrounding the spine and eliminating activities or habits which accelerate the degenerative process.
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Low Back PainLong-Term Management
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Low Back PainLong-Term Management
• Passive care directed at symptom relief does not address the underlying dysfunction.
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Low Back PainLong-Term Management
EXERCISE !• Walk, Bike, Swim, Treadmill, Elliptical
trainer• Stretching• Avoid impact and twisting activities:
Running, Tennis, Golf
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Low Back PainLong-Term Management
• Increased pain during the initial phases of rehabilitation is common and should not cause alarm.
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Low Back PainLong-Term Management
• Quit smoking• Osteoporosis: Consult your doctor regarding
diet, hormonal replacement and bone building drugs.
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TreatmentMedications
• Anti-Inflammatories: Motrin, Advil, Aleve, Aspirin, Tylenol
• Prescription NSAID’s: Lodine, Arthrotec, Mobic, Celebrex
• Narcotics• Anti-Depressants• Anti-Convulsants
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TreatmentInjections
• Epidural
• Selective nerve root block (SNRB)
• Facet joint block
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All injections should be done with x-ray guidance!
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Lumbar Spine Surgery
Surgery of the low back is best directed toward relief of pain originating from a compressed or irritated nerve root(s).
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Low Back PainSurgical Treatment of Sciatica
• Laminectomy• Discectomy• Sometimes fusion
is also performed.
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Low Back PainSurgical Treatment of Sciatica
• Short procedure (1hr. Average)
• < 24 hour hospital stay
• Good-excellent results in most patients
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Surgery for
Chronic Low Back PainTraditional• Lumbar fusionNew Options• IDET• Kyphoplasty/vertebroplasty• Artificial disc replacement (ADR)
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Surgery for
Chronic Low Back PainTraditional:
• Fusion
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Lumbar Fusion
• Posterior
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• Anterior
Lumbar Fusion
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Lumbar Fusion
• Combined
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Surgical Treatment of Low Back Pain
New Options
• Intradiscal Electrothermal Annuloplasty (IDET)
• Artificial disc replacement (ADR)
• Vertebroplasty / Kyphoplasty
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IDET
• A metal coil is inserted into a disc.
• The coil is heated and seals a painful tear.
• Outpatient procedure under IV sedation.
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IDET
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IDET
Indications:
• One or two painful discs with a tear.
• No prior surgery.
• Well preserved disc height.
Results:
• 60% Good to Excellent results
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• Anterior abdominal incision.
• Disc is completely removed.
• Artificial disc is placed.
• Hospital stay of 1-2 days.
Artificial Disc Replacement
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Artificial Disc Replacement
Criteria:• 1-2 degenerated disks• Good disk height• No facet arthritis• No prior surgery• No sciatica
70-80% good to excellent results in properly selected patients.
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Artificial Disc Replacement
• Best results seem to correlate with less motion (I.e. fusion).
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Kyphoplasty / Vertebroplasty
• Cement is injected into a broken vertebrae.
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Kyphoplasty / Vertebroplasty
• Balloon is used to create cavity prior to injection of cement with kyphoplasty.
• Outpatient procedure often with immediate pain relief.
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Resources
• Puget Sound Spine Institute
• WebMD
• North American Spine
Society
• American Academy of
Orthopedic Surgeons. www.aaos.org
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Thank-you!