Lumbar Disc Disease (cont.)
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Lumbar Disc Disease Treatment
Self-Care at Home
Most cases of low back pain can be effectively managed by the person at home. A short period of rest and over-the-counter medications can help with pain relief.
If symptoms do not resolve, the person should seek medical care for further evaluation.
Medical treatment for lumbar disc disease is typically limited to providing a structured program of physical therapy and medications as described in "Medications."
Again, other causes of low back pain need to be ruled out that would need more aggressive medical care.
Initial treatment of lumbar disc disease consists of antiinflammatory medications including ibuprofen (Motrin, Advil) or naproxen (Aleve). These medications can help relieve both the pain and inflammation associated with lumbar disc disease.
A short course of oral corticosteroids, such as prednisone, can also be of benefit, but long-term use of corticosteroids is not recommended. Long-term use is associated with serious side effects, such as peptic ulcer disease, swelling and fluid retention, sleep disturbances, confusion or mood changes, and an increased risk of osteoporosis. For lumbar disc disease that causes severe, radiating nerve pain down the leg (sciatica), an epidural injection of corticosteroids may be considered to provide a more prompt antiinflammatory effect.
Muscle relaxants, such as cyclobenzaprine (Flexeril), can provide short-term relief for many people. These medications can cause drowsiness and should not be used if driving, working, or consuming alcohol. Additional side effects of muscle relaxants include dry mouth, blurred vision, urine retention, and constipation.
Medications that contain narcotic pain relievers, such as codeine, morphine, or oxycodone can also provide relief of the pain associated with lumbar disc disease. These medications should not be continuously administered for chronic pain if alternative treatments can be used. Common side effects include drowsiness, constipation, or nightmares. Caution is advised to take only as prescribed to avoid toxicity of the narcotic or other medications, such as acetaminophen (Tylenol), that narcotic pain relievers may contain.
Surgery is an option for the treatment of lumbar disc disease in people who do not respond to the conservative treatment options discussed in "Medications."
Surgical options include lumbar decompression, lumbar fusion, and lumbar disc replacement.
Lumbar decompression involves removing a portion of the bone from the back of the spinal column to increase the space available for the nerves exiting the spinal cord. This can relieve the pressure on the nerves and relieve the associated pain. This option should not be used if there is any excessive motion in the spine due to instability. Imaging studies can be ordered by a surgeon to assess for signs of instability.
There are several types of lumbar fusion. The lumbar spine can be approached from either the front through the abdomen, through the back, or both. This decision is made by the surgeon based on findings from the preoperative analysis. In many cases, the surgeon removes most of the intervertebral disc and replaces it with either bone or another material. In many cases of lumbar disc disease, the disc is a major source of pain. Once removed, the pain is significantly relieved. After removing the disc, the motion segment becomes unstable and has too much available motion. The fusion is performed to help the two vertebrae grow together and remove any motion between them. The choice of whether or not to use instrumentation or metal screws and rods to stabilize the spine is made by the surgeon based on findings from the exam and imaging studies.
A new option for the treatment of lumbar disc disease is lumbar disc replacement. This technique involves removing all of the intervertebral disc as in a spinal fusion, but instead of replacing the disc with bone, an artificial disc is inserted. The advantage of this technique is the person is able to retain close to normal motion at the level of surgery. It is thought that this will lessen the chance of developing further degenerative changes at the neighboring levels in the spine over time. This technique can only be used in cases of isolated disc disease. If people have arthritis in the facet joints of the spine, the disc replacement is not indicated.
Many people with lumbar disc disease can benefit from a structured program of physical therapy. This can assist with both strengthening of the abdominal and lower back muscles as well as overall conditioning of the body.
People can be taught specific exercises that can be continued at home after the organized therapy program is completed.
Physical therapists have many different modalities at their disposal to assist in the treatment of lumbar disc disease. These include heat, massage, electrical stimulation of muscles, ultrasound therapy, and water therapy.
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