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5. How does one treat a degenerative spine disease? What are the indications for surgery? PHYSICAL THERAPY • Relative rest for up to the first 2 days after an acute episode – restricts all occupational and avocational activities • Do not rest for longer periods – can cause deconditioning, loss of bone density, decreased intradiscal nutrition, loss of muscle strength and flexibility, and increased segmental stiffness PHYSICAL THERAPY • Passive modalities (application of heat to the tissues) – valuable during the initial 48 hours of relative rest to aid in pain relief • Manual techniques (massage, mobilization) – increase soft tissue pliability when secondary myofascial tightness is present PHYSICAL THERAPY • Dynamic lumbar-spine stabilization programs – Maintain a neutral spine position throughout various daily activities – This position allows for balanced segmental force distribution between the disk and zygapophyseal joints – provides functional stability with axial loading to help minimize the chance for acute dynamic overload upon the disks – minimizes tension on ligaments and fascia planes THERAPEUTIC EXERCISE • The pain response may limit flexibility • Stretching exercises – improve flexibility of the trunk muscles • Flexion exercises – Widen the intervertebral foramen THERAPEUTIC EXERCISE • McKenzie method – Extension exercises – Focuses on the muscles and ligaments – Maintains the spine’s natural lordotic curve, important to good posture THERAPEUTIC EXERCISE • Aerobics – Improved muscular endurance, coordination, strength, strong abdominal muscles, and weight loss • Strong abdominal muscles – Reduce the loads to the lumbar spine • Walking, bicycling, and swimming PHARMACOLOGIC TREATMENT • Peripherally acting analgesics – Acetaminophen • For mild to moderate pain • Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. PHARMACOLOGIC TREATMENT • Peripherally acting analgesics – Nonsteroidal anti-inflammatory drugs (NSAIDs) • the drugs of choice in initial pharmacologic treatment of acute episodes of diskogenic pain or with acute exacerbation of chronic diskogenic pain • MOA: inhibition of cyclo-oxygenase, competition with prostaglandin at receptor sites, and inhibition of WBC migration and of lysosomal enzymes from WBCs SURGICAL INTERVENTION • Indications – Conservative treatment options do not provide relief within 2 to 3 months – Nonoperative medical management fails to adequately relieve the intolerable pain during ADL – Progressive neurologic deterioration (numbness or muscle weakness) – Documented compression of the nerve root, spinal cord, or both SURGICAL INTERVENTION • Decompression – removal of bone or disk material from around a compressed nerve root – to relieve pinching of the nerves – provide more room for their recovery – performed through laminectomy and diskectomy SURGICAL INTERVENTION • Spinal fusion – uses a bone graft to fuse one or more vertebrae – stop motion at a painful vertebral segment – stop or decrease the pain generated from the joint SURGICAL INTERVENTION • Surgical approach – anterior, posterior, or combined procedure – interbody fusion with allograft autologous bone or threaded titanium cage – intertransverse process in situ fusion with or without instrumentation