discogenic back pain:non-operative treatment by dr ashok jadon,md fipp
TRANSCRIPT
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Discogenic Back PainNon-surgical management
Dr Ashok Jadon,MD,DNB,MNAMS, FIPM (Ind), FIPP (USA)Chief Consultant & HOD Anaesthesia
In-charge Pain Relief ServiceTata Motors Hospital
Jamshedpur
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Back Pain; profile• Low back pain is the 5th most common reason
for all physician visits.• Low back pain is responsible for more than
$20 billion annually in direct health care costs(USA).
• Approximately 90% of adults experience back pain at some time in life.
• 90% do not require intervention
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Causes of Back Pain
25-40% Back Pain(Discogenic Back Pain)
Muscles,Tendons,Ligamaents
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Discogenic Back Pain; Intervertebral Disc
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Discogenic back pain
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Stages of Disc Degeneration
A may last forever or, E may be First to occur
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Degenerated Disc
Annuloplasty Disc Decompression
Chemonucleolysis
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Annular Tear; High intensity zone
HIZ
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I-DETIntradiscal Electrothermal Therapy
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Biaculoplasty (Cooled RF)
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Disc Herniation; Discectomy
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Hydrodiscectomy (Spine jet®)
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Laser and RF Plasma
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Percutaneous Nucleotomy
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Dekompressor
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Ozone Neucleolysis
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Future of Non surgical Treatment
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Debate is on…….
Non-surgical Vs. Surgical ApproachRole of Surgery ?
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Indication of Surgery
RED FLAGS
Contained Non-Contained
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Back Pain; MRI & Disc Prolapse• MRI abnormalities need not have a clinical
significance. • 30% disc prolapse a-symptomatic*• MRI is72% sensitive, 68% specific, and 70%
accurate in detecting containment status of lumbar herniated discs.
http://thepainsource.com/abnormal-lumbar-disc-pathology-in-asymptomatic-individuals/
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MRI; Back Pain
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Provocative discography
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Surgery for back pain;MRI…
• Clinical correlation is must• Discography is very helpful
Remember:FBSS 30%
Re-surgery; failure & risk
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Summary
• Disc contributes 25-40% back pain • Only 10% patients require Intervention• MRI alone does not guarantee the diagnosis of
discogenic pain• Until supported by clinical judgment and
discography• Surgery is indicated in selected cases specially
sequestrated disc and emergent situation
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Take home message……
• Non-surgical management is very safe & successful in
most of the patients.
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Questions Please?
Thank you