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Lumbar Degenerative Disc Disease
Treatment Options
For most people, degenerative disc disease can be successfully treated with conservative (meaning non-surgical) care consisting of medication to control inflammation and pain (either oral or injection), and physical therapy and exercise. Surgery is only considered when patients have not achieved relief over six months of conservative care and/or are significantly constrained in performing everyday activities.

Non-surgical treatment for degenerative disc disease
The ongoing pain, as well as the frequency and intensity of the flares, can be mitigated through a number of non-surgical options. Modifying activities to preclude lifting of heavy objects and playing sports that require rotating the back (e.g. golf, basketball or football) can be a good first step. Other options include:

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  • Applying heat to stiff muscles or joints to increase flexibility and range of motion, or using ice packs to cool down sore muscles or numb the area where painful flares are concentrated.
  • Medications such as non-steroidal anti-inflammatories (e.g., ibuprofen, naproxen, COX-2 inhibitors) and pain relievers like acetaminophen (such as Tylenol) help many patients feel good enough to engage in regular activities. Stronger prescription medications such as oral steroids, muscle relaxants or narcotic pain medications may also be used to manage intense pain episodes on a short-term basis, and some patients may benefit from an epidural steroid injection. Not all medications are right for all patients, and patients will need to discuss side effects and possible factors that would preclude taking them with their physician.
  • An exercise program is essential to relieving the pain of lumbar degenerative disc disease and should have several components, including
    • Hamstring stretching, since tightness in these muscles can increase the stress on the back and the pain caused by a degenerative disc.
    • A strengthening exercise program, such as Dynamic Lumbar Stabilization exercises, where patients are taught to find their ‘natural spine’, the position in which they feel most comfortable, and to maintain that position
    • Low-impact aerobic conditioning (such as walking, swimming, biking) to ensure adequate flow of nutrients and blood to spine structures, and relieve pressure on the discs.
  • Chiropractic manipulation can relieve low back pain by taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and, like more active exercise, promoting the release of endorphins within the body to act as natural painkillers.
  • Epidural steroid injections can provide low back pain relief by delivering medication directly to the painful area to decrease inflammation.

Surgery for degenerative disc disease
Patients unable to function because of the pain or who are frustrated with their activity limitations may consider lumbar spinal fusion surgery. Fusion surgery works because it stops the motion at a painful motion segment. A one-level fusion at the L5-S1 segment does not significantly change the mechanics in the back and is the most common form of fusion, as this is the most likely level to break down for degenerative disc disease.

Fusion of the L4-L5 level does remove some of the normal motion of the spine as this is a major motion segment (as opposed to L5-S1 which has really limited motion) Multi-level fusions are more problematic. A two-level fusion may be considered for patients with severe, disabling pain, but three-level fusions are not recommended because back movement is too diminished and altering the muscle composition can in and of itself cause pain.

While it is a major surgery, fusion surgery can be an effective option for patients to enhance their activity level and overall quality of life. This is particularly true now that minimally invasive techniques are available to decrease post-operative discomfort, preserve more of the normal anatomy of the low back, and result in higher rates of fusion than previous techniques.

A newer surgery to treat pain and disability from lumbar degenerative disc disease is artificial disc replacement. The theory is that replacing the disc, instead of fusing the disc space together, maintains more of the normal motion in the lumbar spine, thereby reducing the chance that adjacent levels of the spine will break down due to increased stress. This procedure is still a new procedure in the US, so long-term efficacy, and potential risks and complications are still relatively unknown.
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