Pathophysiology, Investigations and Operative Management in Cases of Lumbar Degenerative Disc Disease
Omar Elsaka *
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
Moneer Ayman Noureldean
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
Mohamed Adel Gamil
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
Mostafa Tarek Ghazali
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
Ashraf Hamada Abd Al-Razik
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
Dalia Hisham
Department of Neurosurgery, Mansoura University, Faculty of Medicine, Mansoura Manchester Medical Program (MMMP), Mansoura, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Degenerative disc disease of the lumbar spine is quite frequent. In carefully selected individuals who have failed non-operative treatment and do not have a significant psychosocial overlay, current evidence justifies surgery. Long-term results show favorable clinical outcomes when fusion surgery is performed with the proper grafting and stabilizing procedures. However, the optimum fusion strategy is still up for debate. For younger, active patients or those with a higher risk of non-union, there is some evidence to support the more sophisticated, technically demanding, and higher risk interbody fusion methods. Despite encouraging short- and mid-term results, lumbar disc arthroplasty and hybrid approaches are still relatively new procedures. Before these procedures may be advised to replace fusion as the gold standard, long-term trials demonstrating superiority over fusion are required. In the hopes of enhancing clinical outcomes, new stem cell techniques paired with tissue engineering therapies are still being researched. Results from long-term follow-up are not yet available to determine whether such approaches are safe, cost-effective, and dependable.
Conclusion: Surgery is supported by scientific evidence in carefully selected patients who have failed to react to suitable non-operative therapy for at least six months and do not have any significant psychosocial overlay.
Keywords: Cutaneous tuberculosis, Low back pain, Serum proteins in tuberculosis, disc degeneration, lumbar fusion, disc replacement, outcome