Degenerative lumbar disc disease

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Degenerative lumbar disc disease

Article Index What is degenerative lumbar disc disease? What causes lumbar disc disease? Treatment for disc disease without surgery Surgery for degenerative lumbar disc disease

What is a degenerative lumbar disc disease?

The spinal column is made up of a stack of vertebrae. The last 5 vertebrae make up the lumbar spine which rests on the sacrum. Between each vertebra, there is a disc that lives to cushion. It is made up of 2 parts, a central part which is the nucleus pulposus and a peripheral part which is the fibrous ring. The annulus is the envelope and surrounds the nucleus pulposus. When the annulus suffers an injury, most frequently associated with wear and tear, a part of the nucleus can come out of the annulus fibrosus, compressing the nerve inside the spine. We call this herniated disc or herniated disc; they can be lumbar or cervical. Normally, the disc is worn without rupturing and does not herniate or compress the nerves. Disc damage is called discopathy. An important discopathy can trigger in the same way the development of osteoarthritis at the local level or problems with the biomechanics of the spine, producing chronic pain. Discopathies can affect one or more lumbar discs. The natural history of low back pain due to discopathy is variable. The pains can remain stable or become more and more important and progressively limit both professional and personal activities.

What Causes Discopathy?

Discopathy can be normal or premature and are associated with specific problems such as being overweight, moving heavy objects, working with frequent vibrations or impacts, and prolonged postures. In discopathies, the intervertebral disc becomes dehydrated, and can more or less replace its function, mainly affecting cushioning. This creates local microtrauma that cause pain and muscle contractures, producing lumbago (lumbar pain).

Treatment for discopathy without surgery

These are relieved with rest and with medication (anti-inflammatories, analgesics and muscle relaxants, ozone therapy for the spine). If the seizures are sometimes painful, they never warrant surgical treatment. Until the pains are installed permanently during the crises, we say that the pains become chronic, the treatment of the spine without surgery is maintained in the first intention and physiotherapy and rehabilitation are also associated as well as advice to improve postural hygiene to limit the misuse of the spine. When low back pain persists in a way that limits activities of daily living even with optimal medical treatment (anti-inflammatory, analgesic, infiltrations) and well-directed physiotherapy, we could consider performing surgical treatment

Surgery for degenerative lumbar disc disease

The objective of the surgery is to relieve pain and improve the quality of personal and professional life. The treatment decision is never an emergency and must be discussed appropriately between the patient and their surgeon. There are several surgical techniques to treat discopathies, some include lumbar disc replacement, these will be established according to the particular function of each patient. If there is a need for nerve decompression due to a herniated disc or osteoarthritis in addition to disc disease, the surgeon will opt for posterior surgery (for the back). • Posterior lumbar arthrodesis consists of blocking the painful level (s) with the intention of limiting the movements of the affected disc. This technique allows removing the affected disc and replacing it with boxes containing natural bone or bone substitute. This assembly consolidates in a few months, achieving the adequate vertebral fusion, then reducing pain. The surgeon will complete the gesture by placing 2 screws in each vertebra to stabilize the assembly, or a spacer or ligament, achieving the same function. This type of surgery is performed posteriorly. If there is no need to perform a nerve decompression gesture, the surgeon may discuss anterior surgery or lateral surgery (approach through the belly or the side). This type of surgery allows you to avoid damaging the back muscles and, therefore, a faster recovery and rehabilitation. • Anterior lumbar arthrodesis consists of blocking the painful level (s) in the same way as posterior arthrodesis, but in this case the disc will be replaced by a larger box held by screws in the vertebrae. • The disc prosthesis allows the disc to be replaced in the same way but maintains the mobility of the affected level and indicates to the patients where all the other elements are in perfect condition.

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