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Conservative treatment
In most cases degenerative disc disease can be managed with conservative
(non-surgical) treatments. Patients with this condition tend to experience
pain that occasionally intensifies, but as long as the pain is manageable
overall surgery can usually be avoided. A consistent exercise program can
help maintain stability in the problem area, so the excess movement and
pain are lessened. Exercises that can be helpful include
·
hamstring stretching
·
dynamic lumbar stabilization exercises
·
low-impact aerobic conditioning
Patients should consider visiting a physical therapist to learn how to
do these types of exercises safely and effectively. Non-prescription
medications, such as ibuprofen (e.g. Advil, Nuprin, Motrin) to reduce
inflammation, and acetaminophen (e.g. Tylenol) for its analgesic
(pain-relieving) qualities, may be helpful in alleviating lower back pain.
Stronger therapies, such as oral steroids or epidural steroid injections,
may be prescribed to treat severe flare-ups of pain if needed.
Surgical treatment
In more serious cases, patients may be in severe pain and may be unable to
function due to the pain. In such cases, lumbar fusion surgery is an
option. A spinal fusion surgery is designed to stop the motion at a painful
vertebral segment, which in turn should decrease pain generated from the
joint. All lumbar fusion surgery involves adding bone graft to an area of
the spine to set up a biological response that causes the bone graft to
grow (fuse) and thereby stop the motion at that segment.
A spine fusion surgery involves using bone graft to cause two vertebral
bodies to grow together into one long bone. Bone graft can be taken from
the patient’s hip (autograft bone) during the fusion surgery, or
harvested from cadaver bone (allograft bone). Synthetic bone graft
substitutes are also in development, and one type—bone morphogenic
proteins (which helps the body create bone)—is currently being used
for certain fusion procedures.
In general, a lumbar spinal fusion is most effective for treating only
one vertebral segment. Most patients will not notice any limitation in
motion after a one-level fusion. When necessary, fusing two segments of the
spine may be a reasonable option for treatment of pain. However, spinal
fusion of more than two segments is unlikely to provide pain relief because
it removes too much of the normal motion in the back and places too much
stress across the remaining joints.
This option should only be considered after conservative treatment has
been proven to be ineffective, and if the patient is truly limited by the
degree of pain they experience. Some alternatives to fusion that are
currently available or being researched, including IDET, artificial discs
(in clinical trials in the US),
and disc regeneration (currently being researched).
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