Treatment options for disks explained

[ADR seeker]

TREATMENT OPTIONS FOR IDD (in order)
Conservative Care, Medication & Mother Nature:

Around 90% of all IDD sufferers will obtain satisfactory relief from their pains by just hanging in there and using conservative measures. However, it's very easy for the patient to become frustrated by the fact that IDD often takes many months (18 month on average) to heal. I would NEVER recommend a patient rushing into a decompressive fusion (or even SED) until they have waited at least 18 months (preferably 24 month) unless serious medical complication occur (loss of bowl & bladder control, progressive neurological deficit, or severe intractable pain). Conservative treatment option include the following: Medication, Gentle Traction treatments (via RPT or Chiropractor), VAX-D (if you can afford it), and non-dynamic spinal stabilization training/exercise (maybe swimming). The worst thing to do is just sit around and do nothing! Try and stay as active as possible without severely flaring yourself up. Figure out a way to get that heart rate up in an aerobic zone to enhance blood flow to the disc, which should help with the healing process.

Intradiscal Injection: Although this is still considered a 'fringe', there is now some anecdotal evidence that injecting a 'chemical soup' into the disc (and facets) may have some benefit for pain relief in the chronically disabled (13). This chemical soup includes the following: Chondroitin Sulfate, Glucosamine Hydrochloride, DMSO, Marcaine, dextrose (50% of the mix!). This chemical soup is injected under fluoroscopy directly into the disc and facet joints. A pilot study demonstrated that 57% of a group of long-time chronic pain sufferer got about a 74% decrease in both their disability scores and their pain levels. However, PLEASE remember that this was a very small pilot study that needs to be followed up upon, so the results although promising must be taken with a 'grain of salt.' There were lots of 'problems' with the study which I've commented upon in my review of this paper. (Here: Klein, Mooney, Derby et al.)
Selective Endoscopic Discectomy (SED):

SED (selective endoscopic discectomy) was created by the innovative Dr. Anthony Yeung MD who uses an endoscope to enter the disc (transforaminally or intralaminally), look around, and repair anular tears. The beauty of this technique is that he is not bound by the limitations of fluoroscopy, which may cause improper placement of any tear-sealing device, for he can physically 'see' inside of the disc and anular tear; this insures exact placement of the RF probe and/or laser.

You can think of this technique as an 'eyeball-guided' debridement of a damaged disc which is followed by an attempt to destroy granulation tissue and inflammatory tissue within and round the anular tear. He, thankfully, does NOT use IDET technology to perform the annuloplasty, but rather uses specifically directed RF energy to accomplish the task of ridding the disc of pain-producing tissue in and around the anular tear. Any nuclear fragment within the tear (which are the precursors to disc herniation) are removed.

WARNING: Although this procedure has a good 'self-proclaimed' track record, the doctor still refuses to put his procedure to the ultimate test: a double blind investigation where it's compared with traditional discectomy, IDET, and Sham treatment. Because of this, I CAN NOT INCLUDE ENDOSCOPIC SYLYE DISCECTOMY FOR THE TREATMENT OF COMPRESSIVE DISC HERNIATIONS AND EXTRUSIONS that result in radicular pain. However, I think the treatment makes a lot of sense for the treatment of IDD and eventually will be proven to be as effective for decompression as traditional discectomy. Another downfall is cost. Although I'm not 100% sure, I've heard that this procedure costs between $15,000 to $25,000.00 which insurance may or may not cover? I've recently reviewed both of Dr. Yeung's Endoscopic Procedures: SED and ENDOSCOPIC DISCECTOMY.
Radio Frequency Annuloplasty: (discTRODE)

IDET, which 'indirectly' uses Radio Frequency (RF) to heat discal tissue, is NOT what I'm recommending here. Annuloplasty preformed with disctrode technology (or SED technology) uses RF energy to 'directly' heat the target discal tissue. The cannulas (wires that are used to produce the heat) are more steerable (the doctor has more control of where he places the cannula) and can generate a more controlled form of heating in a more specific location. The goal of RF annuloplasty is destroy pain producing tissue and nerve fiber within the annular tear, and encourage the anular tear to heal. The biggest disadvantage is that the doctor must use fluoroscopy to see where he's got the needle tip (which generates the heat which 'cooks' the evil IDD tissue). Although this method is better than nothing, it's not nearly as accurate as the SED procedure.

Again, there are no double blind studies out on this technology, but I expect they will be coming. IDET has had several negative investigations, and I have heard and seen too many failures to recommend its use.

Artificial Disc Replacement (ADR) (Prodisc & Flexicore): Dynesis:

Interbody Fusion:
If all else fails, this is your last stop! ADR is now available in the US (one or two levels) and is probably one of your best bets. Dynesis is still in clinical trials but looks promising as well. Both of the aforementioned are probably better options than traditional interbody fusion since they not only decompress/remove the diseased disc, but they allow for the spine to retain some of its natural motion - which is thought to lessen the chance of 'over-loading' the disc above and below the fusion (the domino effect). I'll comment more on these three final options at a later date. However, your Oswestry score had better be in the 50s before you attempt this drastic of a procedure. The empirical success rates are only about 33% with another 33% getting worse and the final 33% staying the same.

Internal Disc Disruption: a Tutorial

[newhere]

im caring my lumbar problems for 10 years. After so many years,good doctor of mine preform discography on L4/L5,and it was totaly positive. Concordant 10/10 pain. Disc is degenerated with dalas grade 3,with annular tear in it.
Dr. suggest SED with annuloplasty...hope i will chose wright?!??

[Maria]

Some people (myself included) may actually go beyond an appropriate time frame for "options" and end up with "less options." Please try to check out "options" as early as possible once realizing what is going on w/spine.

Good luck to anyone that is trying to figure this out. I chose the "nothing further at the time option" even tho at least 3 surgical options were offered to me over a 6 year period of time. As time went on however because of exclusion criterion here in the US less options were available to me here in the US that would be covered by insurance. Perhaps abroad there may have been continued to be a chance for more options then $$ was a concern which makes the option of going out of the country less of an option.

There are often more factors involved in the decision making process than if one imagines so start as early as possible to figure things out!

[ADR seeker]

Originally Posted by newhere

im caring my lumbar problems for 10 years. After so many years,good doctor of mine preform discography on L4/L5,and it was totaly positive. Concordant 10/10 pain. Disc is degenerated with dalas grade 3,with annular tear in it.
Dr. suggest SED with annuloplasty...hope i will chose wright?!??

If it works you will probably be pain free for quite some time. If it doesn't work you probably won't be worse off.

[Maria]

Newhere,
Did your doctor suggest surgery for L4/5? Is L5S1 OK? Have you seen anyone else for consultation or will you be seeing anyone else? I guess how well the surgery will work will largely depend on if it's the right surgery for the findings (it addresses pain generators) and the surgeon's skill with surgery performing.

[newhere]

Yeah it was my L4/L5. I barely could stand after discography on my feets. So i know this is that pain.
I will not go to another doctor,since all doctors before say my disc looks allmost normal,and no need for surgery.
But now i found the best for me in Croatia and definetly i will stick with him.
Problem is i am having more trouble with thoracic then lumbal spine.
Lumbal spine flares when standing,specialy after 15min walking...

[Maria]

Newhere,
Glad you found a surgeon you think is the best to work w/you. I'm sorry to hear your thoracic spine bothers you more than your lumbar currently. Would this mean that you would hold off on the surgery recommended for lumbar spine because of this? I was also wondering about those positive lab findings you posted in another thread and what your doctor had to say about the findings (whichever doctor is in charge of your this part of your healthcare).