W Bini. Dynamic Stabilization: Re-Stabilization Concept In Degenerative Disc Disease. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.
In the last years we are experiencing a growing interest to treat the degenerative process involving the disc (mobile segment) earlier in its natural degenerative history. For this, several options and techniques exist and a lot is in the "pipeline" as clinical trial or experimental work in progress. In order to be truly less or minimally invasive in the treatment of lumbar DDD it is true that we should and must address the problem at a much earlier time point in the degenerative cascade.
Based on our clinical experience and available data and therapeutical options , we have established a therapeutical plan depending on the stage of the degenerative process and the prevailing symptoms. We will present this lumbar DDD guideline paying special attention to :
A. disc regeneration or augmentation (early in the black disc phase) ie. ADCT, injectable nucleus-NUCORE
B. partial vs. total disc prosthesis (deg. Phase II) ie. NUBAC
C. DDD + microinstability (deg. Phase III) ie. micro/percutaneous interbody restabilization
D. Stenosis (deg. Phase IV) ie. microdecompression + restabilization E. Combined or mixed situations ie. black disc + microinstability
In our therapeutical strategy it is of primary concern the improvement of the patients signs (deficits) and symptoms (pain). It is not always the primary goal nor possible with a minimal-invasive concept to "cure" or change the underlying causes, eventhough standard procedures are being progressively replaced by operations performed percutaneously (ie. transpedicular fixation). Perhaps such guidelines can help us to carry out a multitrial approach to clarify and establish treatment concepts early in and for lumbar DDD amid the numerous possibilities.