1. 5. How does one treat a degenerative spine disease
5. How does one treat a degenerative spine disease? What are the indications for surgery?

2. 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

3. 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

4. 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

5. THERAPEUTIC EXERCISE The pain response may limit flexibility
Stretching exercises
improve flexibility of the trunk muscles
Flexion exercises
Widen the intervertebral foramen
In some patients, the pain response may limit flexibility. Prescribed stretching exercises can improve flexibility of the trunk muscles. Flexion exercises may help to widen the intervertebral foramen. The intervertebral (between the vertebrae) foramen are small canals through which the nerve roots exit the spinal cord. The intervertebral foramen are located on the left and right sides of the spinal column.

6. THERAPEUTIC EXERCISE McKenzie method Extension exercises
Focuses on the muscles and ligaments
Maintains the spine’s natural lordotic curve, important to good posture
Extension exercises, such as the McKenzie method, focuses on the muscles and ligaments. These exercises help maintain the spine’s natural lordotic curve, important to good posture.

7. THERAPEUTIC EXERCISE Aerobics Strong abdominal muscles
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
Aerobics (no/low impact) offers many benefits including improved muscular endurance, coordination, strength, strong abdominal muscles, and weight loss. Strong abdominal muscles work like a brace (or corset) to reduce the loads to the lumbar spine. It is also known that aerobics help to combat anxiety and depression. The loads on the discs during walking are only slightly greater than when lying down. Walking, bicycling, and swimming are forms of aerobic exercise a physician may suggest.

8. PHARMACOLOGIC TREATMENT
Peripherally acting analgesics
Acetaminophen
For mild to moderate pain
Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Several types of medications may be helpful in treatment of diskogenic pain (eg. analgesics [peripheral and centrally acting], muscle relaxants, sedatives, or glucocorticoids)

9. 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

10. 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 is an option when nonoperative medical management fails to adequately relieve the intolerable pain during activities of daily living which is individual-specific. It should also be considered in patients with initial signs and symptoms of progressive neurologic deterioration, specifically numbness or muscle weakness.

11. 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

12. 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

13. 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