conservative treatment of low back pain
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Conservative Treatment of Low Back PainTRANSCRIPT
Conservative Tx of Low Back Pain
Seoul Naeun HospitalKise Nam M.D. Ph.D.
E-Mail: [email protected]://www.seoulnaeunhospital.com
Low Back Pain
• LBP : 80 % experience in their life.
• Sciatica : 13-40% experience.(Frymoyer JW : JBJS, 1983)
Natural History
• LBP : 50% resolve within 1 week, 95% within 3months
• Sciatica :50% resolve within 1 month, 75% within 3months (Bush K : Spine, 1992)
OP vs Conservative
• The controlled trial showed a statisti-cally significant better resull in the surgically treated group at the one-year follow-up examination.
• After four years the operated pa-tients still showed better results, but the difference was no longer statisti-cally significant (Weber H : Spine, 1983)
Etiology of LBP
• Spondylogenic• Neurogenic• Viscerogenic• Vasculogenic• Psychogenic
Common Ex of LBP
• Sprain• HIVD (Herniated interverteral disc)• Spinal Stenosis• Instability
Spondylolisthesis, Retrolisthesis.• Scoliosis, Kyphosis• Osteoporosis, Comp. Fx
Conservative Tx
• Bed rest for 3~5 days
• MedicationNSAID, M relexant, Antidepressant.
• Manipulation (chiropractic)• Back brace
Conservative Tx
• Physical TherapyHot pack, TENS, Traction, ESWT, Pain Scrambler
• InjectionTPI. Epidural Steroid Injection, Facet joint injection. Medial branch block.
Conservative Tx
• ExerciseFlexion, Extension exerciseAerobic exercise
• Back School.
Local Procedure
• Percutaneous Neurolysis• Nucleoplasty• IDET• Percutaneous Endoscopic Discectomy
Bed Rest
Medication
• NSAIDCelebrex 200mg qdNaxozol (naproxen 500mg esomeprazole 20mg)
• M relexant, • Antidepressant
Tricyclic antidepressants : amitriptylineSNRIs (duloxetine Cymbalta)
• Anti-convulsant medications : gabapentinoids (gabapentin/pregabalin)
• Opioid analgesics: oxycodone, tramadol
Manipulation
Physical Therapy
• Hot pack, TENS, Ultrasound,Traction• ESWT
(Extracorporeal shockwave therapy)• Pain Scrambler
ESWT
ESWT (Biological Effects)
• Relieving Pain • Increased blood flow • Induce an inflammatory-mediated
healing process• Release healing factors;
TGF-β1,IGF-1 Signs of inflammation and repair after 4 weeks
ESWT (Target Tissues)
• Tendon• Tendon sheath• Bone• Muscle• Ligament• Connective tissue, synovium
ESWT (protocol)
• Dependent upon the energy categoryHigh energy : 1,000 to 1,500 pulsesLow energy : 2,000 to 3,000
• Treatment area : greatest discomfort areapathologic tissuefunctional abnormal tissue
• Additional treatments may be benefi-cial
Pain Scrambler
What is Scrambler therapy?
• Patient‐specific cutaneous electro‐stimulation simi-lar to spinal cord stimulation, but non‐ invasive.
• Creates "non‐pain" information in packets of rapidly varying impulses, given non‐invasively using the patient’s own nerves.
• 30‐45 minute long sessions using EKG‐like pads. Above and below pain. Stinging, then tingling, then intermittent pulse; adjust to tolerance.
• No side effects reported in over 4000 patients; over 3000 in use in Italy. US FDA Cleared Feb 09.
Epidural Steroid Injection
Epidural Steroid Injection
Facet Joint Injection
Med Branch Block
Exercise with Medex
Back School
Back School
Spontaneous regression of HIVD 3Yrs later
Spontaneous regression of HIVD 3Yrs later
Arthroscopic Lumbar Discectomy
Arthroscopic Lumbar Discectomy
Arthroscopic Lumbar Discectomy
Epidural Neurolysis
Intradiscal Electrothermal Annuloplasty
Nucleoplasty
Vertebroplasty, Kyphoplasty
Principle of Tx of LBP
If possible, conservative
• Thank You