Degenerative Disc Disease

Associate Professor of Neurosurgery

Division of Neurological Surgery
King Abdulaziz University Hospital
PO Box 80215
Jeddah 21589
Saudi Arabia
Fax: +966 2
Saleh Baeesa, MD, FRCSC 6408469http://sbaeesa.kau.edu.sa/
 June 23-26, 2010
Beirut, Lebanon

Case Discussion II:

Degenerative Disc Disease

Moderators:
P. Hitchon, MD and S. Baeesa, MD, FRCSC
 Case: History
• 56-year-old healthy woman, retired
preliminary school principal, presented with:
 Low back pain (LBP) for 5-year duration
 Localized to left paraspinal region
 Mild to moderate (VAS 3-5)
 Intermittent, activity-related
 Worse with standing, better with rest, lying
dawn, flexion
 Improved with repeated sessions of
physiotherapy
 Case: History
• Last 6-month, worsening of:
LBP
• VAS 5-9
• Almost constant
• Not relieved spontaneously

Left leg pain

• Intermittent initially, constant over the last month
• Radiated to lateral aspect of the leg
• VAS 6-8
 Case: Examination
– Wt: 89 Kg
– Ht: 156 cm
– Localized back (left paraspinal tenderness)
• No significant limitations of ROM
– Hypoesthesia left lateral aspect of the leg and dorsum of
the foot.
– No weakness
Dynamic films
No instability
 Treatment options
• Continue same treatment
– NSAIDS, ASA, muscle relaxants, tramadole
• Interventional therapy
– Epidural injections
– Percutaneous disk electro coagulation
• Surgery
– What?
 Surgical options
• Anterior
– ALIF L4-5
– Disk Arthroplasty L4-5
• Lateral
– DLIF L4-5
• Posterior
– L4-5 diskectomy
– Interspinous spacer L4-5
– MIS TLIF L4-5
• Other