Disc disease: Difference between revisions
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# microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg | # microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg | ||
== | ==Spinal Stenosis== | ||
# avoid alcohol and strengthen legs to prevent falls | # avoid alcohol and strengthen legs to prevent falls | ||
# exercise bike or walking recommened with rest when pain comes | # exercise bike or walking recommened with rest when pain comes | ||
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# even with surg, sxs may reoccur in a few years | # even with surg, sxs may reoccur in a few years | ||
== | ==Chronic Back Pain== | ||
# neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain | # neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain | ||
# intensive exercise helps | # intensive exercise helps | ||
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# multiple surgical precedures no helpful | # multiple surgical precedures no helpful | ||
== | ==Prevention== | ||
# corsets and education not helpful | # corsets and education not helpful | ||
# wt loss, excersice, stop smoking helpful | # wt loss, excersice, stop smoking helpful | ||
Revision as of 06:18, 19 February 2012
Background
- if no cauda equina or progressive neuro deficit- delay surg for a month
- epidural steroids for temporary symptomatic relief
- discetomy gives better pain control over 4 yrs but not past 10
- microdiscectomy similar to standard discectomy but perscutaenour or laser disctmy less effective than standard surg
Spinal Stenosis
- avoid alcohol and strengthen legs to prevent falls
- exercise bike or walking recommened with rest when pain comes
- decompressive laminectomy for severe persistent pain
- adding spinal fusion to decompression improves outcome
- even with surg, sxs may reoccur in a few years
Chronic Back Pain
- neural remodeling and neurplasticity may explain chronic pain in absence of ongoing tissue injury- alters perception of pain
- intensive exercise helps
- antidepressants especiallly tricyclics (better than SSRI), also helpful
- no long term opioids
- goals may need to be refocused
- multiple surgical precedures no helpful
Prevention
- corsets and education not helpful
- wt loss, excersice, stop smoking helpful
Source
7/2/09 PANI