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www.spineuniverse.com
"Minimally Invasive Approaches to the Treatment of Spinal Disorders" The treatment of spinal disorders has undergone tremendous changes over the past few years. Treatment and diagnostic modalities have been brought to the forefront in the evaluation of spinal conditions. The following represent a few of the new and up-and-coming thoughts on the diagnosis and treatment of spinal disorders.Non-Operative Treatment Modalities: Selective Nerve Root Injections The use of selective nerve root injections with corticosteroids has shown a efficacious use in helping to avoid surgical intervention in selected patients. The use of selective nerve root injections has avoided surgical intervention in 71% of the patients that have received this treatment compared to 33% that received placebo. But the use of selective nerve root injections is not a stand alone, it requires the use of physical therapy to encompass a total and long lasting recovery. Therapy should be directed at a flexibility and strengthening/conditioning program to enhance the spinal musculature and normalize the spine. Operative Modalities: Intradiscal Electrothermal Therapy The use of ET has shown a high interest in the treatment of selective conditions involving herniated disc disease of the lumbar spine. The procedure is minimally invasive in nature with minimal risk involved when compared to the classic modalities performed in the past. Indication though are critical for the success of this procedure. IDET is indicated for the treatment of a selected contained herniated nucleus pulposis. The disc may be lateralized but the best indication is a central disc herniation. This allows for optimal placement of the catheter for maximal results. The philosophy encompasses the decompression of the disc and thecal sac via electrothermal shrinkage of the disc. Once achieved, a program to rehabilitate the spine is necessary and critical to maximize the end results and promote flexibility and strengthening of the spine. An extruded disc, lateral disc(far out) or significant spondylosis would be a contraindication to this procedure. Minimally Invasive Endoscopic Discetomy MED has taken arthroscopic surgical intervention of the spine to the next level. It allows one to address enhanced indications for the treatment minimally of the spine. The procedure can be performed in an outpatient surgical environment, similar to IDET, with again lower risk factors than with conventional open or limited microdiscetomy. It also addresses pathology that has limited access even via microdiscetomy such as far lateral disc herniations, foraminal disc herniations, and central disc herniations. Again, it is limited by the degree of degeneration or spondylosis and is thus contraindicated, also with stenosis and segmental instability its usefulness needs to still be investigated. But again, not withstanding the successful removal of the disc, a therapeutic rehabilitative program must be employed to maximize the flexibility and strengthening/conditioning of the spine. |
