Low Back Pain and Lumbar Disc Disease - PowerPoint PPT Presentation

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Low Back Pain and Lumbar Disc Disease

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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 ... – PowerPoint PPT presentation

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Tags: back | bone | cement | disc | disease | low | lumbar | pain

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Title: Low Back Pain and Lumbar Disc Disease


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
  • 11 Female/Male ratio except after age 60
  • Sciatica
  • 40 Lifetime prevalence
  • 10 of patients with low back pain

3
Low Back Pain Natural History
  • 33 Pain free after one week
  • 75 Pain free after one month
  • gt90 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 Pain Diagnostic 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 NSAIDs 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)
  • lt 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
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41
Resources
  • Puget Sound Spine Institute
  • WebMD
  • North American Spine
  • Society
  • American Academy of
  • Orthopedic Surgeons. www.aaos.org

42
Thank-you!
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