Disc disease

Background

1. if no cauda equina or progressive neuro deficit- delay surg for a month
2. epidural steroids for temporary symptomatic relief
3. discetomy gives better pain control over 4 yrs but not past 10
4. microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg

SPINAL STENOSIS

1. avoid alcohol and strengthen legs to prevent falls
2. exercise bike or walking recommened with rest when pain comes
3. decompressive laminectomy for severe persistent pain
4. adding spinal fusion to decompression improves outcome
5. even with surg, sxs may reoccur in a few years

CHRONIC LBP

1. neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain
2. intensive exercise helps
3. antidepressants especiallly tricyclics (better than SSRI), also helpful
4. no long term opioids
5. goals may need to be refocused
6. multiple surgical precedures no helpful

PREVENTION

1. corsets and education not helpful
2. wt loss, excersice, stop smoking helpful

Source

7/2/09 PANI