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Low Back Pain and Lumbar Disc Disease

Low Back Pain and Lumbar Disc Disease. John M. Blair, MD Puget Sound Spine Institute. Low Back Pain. Incidence: 60-90% Lifetime prevalence 5% Annual incidence 1:1 Female/Male ratio except after age 60 Sciatica: 40% Lifetime prevalence 10% of patients with low back pain.

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Low Back Pain and Lumbar Disc Disease

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  1. Low Back Pain and Lumbar Disc Disease John M. Blair, MD Puget Sound Spine Institute

  2. Low Back Pain Incidence: 60-90% Lifetime prevalence 5% Annual incidence 1:1 Female/Male ratio except after age 60 Sciatica: 40% Lifetime prevalence 10% of patients with low back pain

  3. Low Back PainNatural History • 33% Pain free after one week • 75% Pain free after one month • >90% Pain free after three months

  4. 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

  5. Acute Low Back PainInitial Management • Mechanical vs. Non-mechanical • X-rays • Exam

  6. Acute Low Back PainManagement • Bed rest (2-7 days) • Early mobilization • Anti-inflamatories, muscle relaxants and narcotics • Ice • Bracing

  7. Acute Low Back PainManagement • Physical Therapy • Spinal manipulation: May speed recovery but no long term efficacy. • Massage Therapy: Feels good but unproven.

  8. DRX 9000

  9. 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.

  10. Chronic Low Back PainLong-term management and treatment • Determine source of symptoms • Treatment

  11. Low Back Pain Determine source of symptoms: • Lumbar disk • Facet joint • Spinal nerves • Vertebral body • Soft tissues • Hip or sacroiliac joint

  12. Low Back PainDiagnostic Tests • X-Rays • MRI • CAT scan +/- myelogram • Discogram • EMG • Bone scan • Injections

  13. Low Back PainLong-Term Management • Therapy/Conditioning • Lifestyle changes • Medication • Injections • Surgery

  14. 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.

  15. Low Back PainLong-Term Management

  16. Low Back PainLong-Term Management • Passive care directed at symptom relief does not address the underlying dysfunction.

  17. Low Back PainLong-Term Management EXERCISE ! • Walk, Bike, Swim, Treadmill, Elliptical trainer • Stretching • Avoid impact and twisting activities: Running, Tennis, Golf

  18. Low Back PainLong-Term Management • Increased pain during the initial phases of rehabilitation is common and should not cause alarm.

  19. Low Back PainLong-Term Management • Quit smoking • Osteoporosis: Consult your doctor regarding diet, hormonal replacement and bone building drugs.

  20. TreatmentMedications • Anti-Inflammatories: Motrin, Advil, Aleve, Aspirin, Tylenol • Prescription NSAID’s: Lodine, Arthrotec, Mobic, Celebrex • Narcotics • Anti-Depressants • Anti-Convulsants

  21. TreatmentInjections • Epidural • Selective nerve root block (SNRB) • Facet joint block

  22. All injections should be done with x-ray guidance!

  23. Lumbar Spine Surgery Surgery of the low back is best directed toward relief of pain originating from a compressed or irritated nerve root(s).

  24. Low Back PainSurgical Treatment of Sciatica • Laminectomy • Discectomy • Sometimes fusion is also performed.

  25. Low Back PainSurgical Treatment of Sciatica • Short procedure (1hr. Average) • < 24 hour hospital stay • Good-excellent results in most patients

  26. Surgery for Chronic Low Back Pain Traditional • Lumbar fusion New Options • IDET • Kyphoplasty/vertebroplasty • Artificial disc replacement (ADR)

  27. Surgery for Chronic Low Back Pain Traditional: • Fusion

  28. Lumbar Fusion • Posterior

  29. Lumbar Fusion • Anterior

  30. Lumbar Fusion • Combined

  31. Surgical Treatment of Low Back PainNew Options • Intradiscal Electrothermal Annuloplasty (IDET) • Artificial disc replacement (ADR) • Vertebroplasty / Kyphoplasty

  32. IDET • A metal coil is inserted into a disc. • The coil is heated and seals a painful tear. • Outpatient procedure under IV sedation.

  33. IDET

  34. IDET Indications: • One or two painful discs with a tear. • No prior surgery. • Well preserved disc height. Results: • 60% Good to Excellent results

  35. Artificial Disc Replacement • Anterior abdominal incision. • Disc is completely removed. • Artificial disc is placed. • Hospital stay of 1-2 days.

  36. 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.

  37. Artificial Disc Replacement • Best results seem to correlate with less motion (I.e. fusion).

  38. Kyphoplasty / Vertebroplasty • Cement is injected into a broken vertebrae.

  39. Kyphoplasty / Vertebroplasty • Balloon is used to create cavity prior to injection of cement with kyphoplasty. • Outpatient procedure often with immediate pain relief.

  40. Resources • Puget Sound Spine Institute • WebMD • North American Spine Society • American Academy of Orthopedic Surgeons. www.aaos.org

  41. Thank-you!

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