Disc degeneration: current surgical options
| Autor: | Gerit Kulik, Constantin Schizas, Victor Kosmopoulos |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system medicine.medical_treatment lcsh:Surgery Intervertebral Disc Degeneration Degeneration (medical) Lumbar vertebrae Bone grafting law.invention Degenerative disc disease surgery Randomized controlled trial law nucleous replacement medicine Humans low back pain Lumbar Vertebrae business.industry lumbar spine total disc arthroplasty Prostheses and Implants lcsh:RD1-811 medicine.disease Low back pain Surgery Treatment Outcome medicine.anatomical_structure Intervertebral Disc Displacement Spinal fusion spinal fusion dynamic stabilisation medicine.symptom lcsh:RC925-935 business interspinous devices |
| Zdroj: | European Cells & Materials, Vol 20, Pp 306-315 (2010) Scopus-Elsevier |
| ISSN: | 1473-2262 |
| Popis: | Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration. |
| Databáze: | OpenAIRE |
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