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| ==Background==
| | #REDIRECT[[Lower back pain]] |
| # if no cauda equina or progressive neuro deficit- delay surg for a month | |
| # epidural steroids for temporary symptomatic relief
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| # discetomy gives better pain control over 4 yrs but not past 10
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| # microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg
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| ==SPINAL STENOSIS==
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| # avoid alcohol and strengthen legs to prevent falls
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| # exercise bike or walking recommened with rest when pain comes
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| # decompressive laminectomy for severe persistent pain
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| # adding spinal fusion to decompression improves outcome
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| # even with surg, sxs may reoccur in a few years
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| ==CHRONIC LBP==
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| # neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain
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| # intensive exercise helps
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| # antidepressants especiallly tricyclics (better than SSRI), also helpful
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| # no long term opioids
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| # goals may need to be refocused
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| # multiple surgical precedures no helpful
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| ==PREVENTION==
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| # corsets and education not helpful
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| # wt loss, excersice, stop smoking helpful
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| ==Source==
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| 7/2/09 PANI
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| [[Category:Neuro]] | |
| [[Category:Ortho]]
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