Lumbar Degenerative Disc Disease

腰椎間盤退變性疾病

A Patient’s Guide to Lumbar Degenerative Disc Disease

腰椎間盤退變性疾病患者指南

Treatment

治療

What treatment options are available?

    有哪些治療可供選擇,？

Nonsurgical Treatment

保守治療

Whenever possible, doctors prefer treatment other than surgery. The first goal of nonsurgical treatment is to ease pain and other symptoms so the patient can resume normal activities as soon as possible.

      如果條件允許,，醫(yī)師們都偏向選擇保守治療而非選擇手術(shù)治療,。保守治療最主要的目的是緩解患者的疼痛從而盡早恢復(fù)患者的日常活動(dòng),。

Doctors rarely prescribe bed rest for patients with degenerative disc problems. Instead, patients are encouraged to do their normal activities using pain as a gauge for how much is too much. If symptoms are severe, a maximum of two days of bed rest may be prescribed.

      醫(yī)生們很少讓有椎間盤退變問(wèn)題的病人臥床休息,，相反醫(yī)生們往往鼓勵(lì)患者繼續(xù)日常活動(dòng),，并以疼痛作為活動(dòng)強(qiáng)度的衡量標(biāo)準(zhǔn),。如果疼痛確實(shí)非常嚴(yán)重，最多給予患者休息兩天的處理,。

Back braces are sometimes prescribed. Keeping the moving parts of the low back still can help calm mechanical pain. When a doctor issues a brace, he or she normally asks that the patient only wear it for two to four days. This lessens the chance that the trunk muscles will shrink (atrophy) from relying on the belt.

      腰圍往往會(huì)被使用,，因?yàn)樗梢杂行Х€(wěn)定腰椎從而緩解疼痛,。當(dāng)醫(yī)生建議使用腰圍的時(shí)候，他們往往會(huì)囑咐患者最多使用2-4天,，以防止產(chǎn)生對(duì)腰圍的依賴,，引起相關(guān)肌肉的萎縮。

Patients may also be prescribed medication to help them gain control of their symptoms so they can resume normal activity swiftly.

    患者往往還會(huì)接受藥物治療,，從而緩解疼痛,，讓患者可以繼續(xù)日常的活動(dòng)。

If symptoms continue to limit a person’s ability to function normally, the doctor may suggest an epidural steroid injection(ESI). Steroids are powerful anti-inflammatories, meaning they help reduce pain and swelling. In an ESI, medication is injected into the space around the lumbar nerve roots. This area is called the epidural space. Some doctors inject only a steroid. Most doctors, however, combine a steroid with a long-lasting numbing medication. Generally, an ESI is given only when other treatments aren’t working. But ESIs are not always successful in relieving pain. If they do work, they often only provide temporary relief.

      如果癥狀持續(xù)惡化,，醫(yī)生往往建議硬膜外激素注射治療（ESJ）,。類固醇類激素是強(qiáng)力的抗炎藥物，可以有效緩解腫脹和疼痛,。ESJ的機(jī)制是將類固醇類藥物注射到腰椎神經(jīng)根附近,。有些醫(yī)生僅僅使用類固醇，而大多醫(yī)生會(huì)選擇結(jié)合使用長(zhǎng)效局麻藥,?？傮w來(lái)說(shuō)，ESJ僅僅在其他保守治療都無(wú)效的情況下使用,，而ESJ并不總能有效,，如果有效往往也是暫時(shí)的。

In addition, patients often work with a physical therapist. After evaluating a patient’s condition, the therapist can assign positions and exercises to ease symptoms. The therapist can design an exercise program to improve flexibility of tight muscles, to strengthen the back and abdominal muscles, and to help a patient move safely and with less pain.

在相關(guān)藥物治療的同時(shí),，患者往往還需要接受康復(fù)治療,。在評(píng)估相關(guān)情況后，康復(fù)師會(huì)指導(dǎo)患者進(jìn)行一系列的姿勢(shì)和練習(xí)來(lái)緩解癥狀,?？祻?fù)師會(huì)設(shè)計(jì)一套鍛煉方案以提高緊張肌肉的柔韌性，增強(qiáng)背部和腹部肌肉的力量,，幫助患者安全地活動(dòng),，減少疼痛的發(fā)生。

Surgery

手術(shù)治療

People with degenerative disc problems tend to gradually improve over time. Most do not need surgery. In fact, only one to three percent of patients with degenerative disc problems typically require surgery.

      椎間盤退變性疾病隨著時(shí)間的推移會(huì)逐漸加重,。大多數(shù)的患者不需要接受手術(shù)治療,。事實(shí)上，椎間盤退變性疾病的患者通常只有1%~3%需要手術(shù)治療,。

Doctors prefer to try nonsurgical treatment for a minimum of three months before considering surgery. If, after this period, nonsurgical treatment hasn’t improved symptoms, the doctor may recommend surgery. The main types of surgery for degenerative disc problems include

      醫(yī)生往往會(huì)先選擇三個(gè)月的保守治療,，在保守治療無(wú)效后才會(huì)考慮手術(shù)治療，主要的手術(shù)方式是：

· lumbar laminectomy

· discectomy

· fusion

· 腰椎椎板切除術(shù)

· 椎間盤切除術(shù)

· 融合術(shù)

Lumbar Laminectomy

腰椎椎板切除術(shù)

The lamina forms a roof-like structure over the back of the spinal column. When the nerves in the spinal canal are squeezed by a degenerated disc or by bone spurs pushing into the canal, a laminectomy removes most, or all of the lamina to release pressure on the spinal nerves.

椎板位于脊柱后部,，像根狀結(jié)構(gòu)橫跨在椎管上,。當(dāng)椎管內(nèi)神經(jīng)被退變的椎間盤或者骨刺擠壓時(shí)，椎板的切除可以有效緩解相關(guān)神經(jīng)所受到的壓力,。

Related Document: A Patient’s Guide to Lumbar Laminectomy

相關(guān)閱讀： 腰椎椎板切除術(shù)患者指南（翻譯招募中,，有興趣者請(qǐng)留言）

Discectomy

椎間盤切除術(shù)

Surgery to take out part or all of a problem disc in the low back is called discectomy. Discectomy is done when the degenerated disc has ruptured (herniated) into the spinal canal, putting pressure on the spinal nerves. Surgeons commonly perform this operation through an incision in the low back. Before the disc material can be removed, the surgeon must first remove part of the lamina. Generally, only a small piece of the lamina is chipped away to expose the problem disc. This is called laminotomy. It usually creates enough room for the surgeon to remove the disc. If more room is needed, the surgeon may need to take out a larger section of the lamina by doing a laminectomy (described above).

      通過(guò)手術(shù)方式切除部分或者全部椎間盤稱為椎間盤切除術(shù),，它往往用于切除那些已經(jīng)突出或脫出并壓迫脊神經(jīng)的椎間盤組織。脊柱外科醫(yī)師往往會(huì)從患者后背切一個(gè)小口,，部分切除椎板后,，切除相關(guān)椎間盤這叫做椎板開(kāi)窗單純髓核摘除術(shù)。切開(kāi)的椎板將會(huì)提供足夠的操作空間來(lái)切除相應(yīng)椎間盤,。

Many surgeons now do minimally invasive surgeries that require only small incisions in the low back. These procedures are used to remove damaged portions of the problem disc. Advocates believe that this type of surgery is easier to perform. They also believe it prevents scarring around the nerves and joints and helps patients recover more quickly. Minimally invasive surgeries include percutaneous lumbar discectomy, laser discectomy, and microdiscectomy.

      許多脊柱外科醫(yī)生現(xiàn)在更偏好于微創(chuàng)手術(shù)即通過(guò)背部的一個(gè)小創(chuàng)口來(lái)切除已經(jīng)損傷了的椎間盤組織,。提倡這種術(shù)式的醫(yī)生認(rèn)為微創(chuàng)手術(shù)更加簡(jiǎn)單而且可以有效防止神經(jīng)和關(guān)節(jié)的疤痕組織形成,，更容易恢復(fù),。微創(chuàng)手術(shù)包括：經(jīng)皮椎間盤切除術(shù)，激光椎間盤切除術(shù),，顯微椎間盤切除術(shù),。

Related Document: A Patient’s Guide to Lumbar Discectomy

相關(guān)閱讀：椎間盤切除術(shù)患者指南（翻譯招募中，有興趣者請(qǐng)留言）

Fusion

融合術(shù)

Fusion surgery joins two or more bones into one solid bone. This prevents the bones and joints from moving. The procedure is sometimes done with a discectomy. Mechanical pain is eased because the fusion holds the moving parts steady, so they can’t cause irritation and inflammation.

      融合術(shù)是指將兩個(gè)或多個(gè)骨性結(jié)構(gòu)融合從而避免骨性結(jié)構(gòu)見(jiàn)的微動(dòng),。融合術(shù)有時(shí)往往會(huì)伴隨著椎間盤的切除術(shù),。原先活動(dòng)的骨性結(jié)構(gòu)融合后可以有效解除疼痛和炎癥。

The main types of fusion for degenerative disc problems include

· anterior lumbar interbody fusion

· posterior lumbar fusion

· combined fusion

治療退變性椎間盤疾病主要的融合方法主要包含：

腰椎前路椎體間融合術(shù)

腰椎后路融合術(shù)

前后路聯(lián)合融合術(shù)

Anterior Lumbar Interbody Fusion

腰椎前路融合術(shù)

Anterior lumbar interbody fusion surgery is done through the abdomen, allowing the surgeon to work on the anterior(front) of the lumbar spine. Removing the disc (discectomy) leaves a space between the pair of vertebrae. This interbody space is filled with a bone graft. One method is to take a graft from the pelvic bone and tamp it into place. Another method involves inserting two hollow titanium screws packed with bone, called fusion cages, into the place where the disc was taken out. The bone graft inside the cages fuses with the adjacent vertebrae, forming one solid bone.

        前路腰椎椎體間融合術(shù)是經(jīng)腹腔入路到達(dá)椎體前緣,，從而得到有效手術(shù)空間切除相應(yīng)椎間盤,。在相應(yīng)椎體間植入骨塊。有兩種方式：一種直接植入切自于骨盆的植骨塊,。第二種植入兩枚結(jié)合骨塊的鈦合金螺釘即融合器,。植骨塊和上下椎體融合后，整個(gè)節(jié)段將會(huì)被固定,。

Related Document: A Patient’s Guide to Anterior Lumbar Fusion with Cages

相關(guān)閱讀：腰椎前路椎體間融合術(shù)患者指南（翻譯招募中,，有興趣者請(qǐng)留言）

Posterior Lumbar Fusion

腰椎后路融合術(shù)

A posterior lumbar fusion is done though an incision in the back. In this procedure, the surgeon lays small grafts of bone over the problem vertebrae. Most surgeons will also apply metal plates and screws to hold the vertebrae in place while they heal. This protects the graft so it can heal better and faster.

      腰椎后路融合術(shù)通過(guò)腰椎背部入路，在手術(shù)中脊柱外科醫(yī)師會(huì)將小骨粒鋪在相關(guān)節(jié)段的椎體后部,，從而達(dá)到融合,。很多醫(yī)生還會(huì)同時(shí)給予金屬釘板系統(tǒng)來(lái)幫助還沒(méi)融合前固定相應(yīng)節(jié)段，使融合更好更快,。

Related Document: A Patient’s Guide to Posterior Lumbar Fusion

相關(guān)閱讀：脊柱后路融合術(shù)患者指南（翻譯招募中,，有興趣者請(qǐng)留言）

Combined Fusion

前后路聯(lián)合融合術(shù)

A combined fusion involves fusing the anterior (front) andposterior (back) surfaces of the problem vertebrae. By locking the vertebrae from the front and back, some surgeons believe the graft stays solid and is prevented from collapsing. Results do show improved fusion of the graft, though patients seem to fare equally well with other methods of fusion.

      腰椎前路椎體間融合術(shù)將脊柱相關(guān)節(jié)段前后部分都融合。許多醫(yī)師認(rèn)為通過(guò)前后固定植骨塊可以更有效固定并可以防止植骨塊的塌陷,，一些研究也確實(shí)證實(shí)了這一點(diǎn),。

Rehabilitation

康復(fù)治療

What should I expect as I recover?

      當(dāng)我恢復(fù)后預(yù)期能達(dá)到什么樣的目標(biāo)？

Nonsurgical Rehabilitation

非手術(shù)康復(fù)治療

Your doctor may recommend that you work with a physical therapist a few times each week for four to six weeks. In some cases, patients may need a few additional weeks of care.

      你的醫(yī)生往往會(huì)建議你接受連續(xù)4-6周,、每周多次的康復(fù)治療,，某些病例往往需要更久。

The first goal of treatment is to control symptoms. Your therapist will work with you to find positions and movements that ease pain. The therapist may use heat, cold, ultrasound, and electrical stimulation to calm pain and muscle spasm.

      康復(fù)治療的最主要目的是緩解癥狀,?？祻?fù)醫(yī)師往往會(huì)幫助你找到可以緩解疼痛的體位和運(yùn)動(dòng),，他們還會(huì)使用熱療，冰敷,，超聲波和電刺激來(lái)緩解肌肉的疼痛和痙攣,。

The therapist may perform hands-on treatments such as massage and specialized forms of soft-tissue mobilization. These can help a patient begin moving with less pain and greater ease. Spinal manipulation provides short-term relief of degenerative disc symptoms. Commonly thought of as an adjustment, spinal manipulation helps reset the sensitivity of the spinal nerves and muscles, easing pain and improving mobility. It involves a high-impulse stretch of the spinal joints and is characterized by the sound of popping as the stretch is done. It doesn’t provide effective long-term help when used routinely for chronic conditions.

      理療師還喜歡使用按摩推拿等手段來(lái)活動(dòng)相關(guān)軟組織從而可以緩解相應(yīng)疼痛。這種脊柱的理療可以讓椎間盤退變性疾病得到短時(shí)間的緩解,。有部分人認(rèn)為這種脊柱推拿術(shù)可以重制神經(jīng)和肌肉的敏感度,，從而可以緩解疼痛恢復(fù)正常的活動(dòng)性。這種推拿往往伴隨著強(qiáng)力的拉伸并以相應(yīng)關(guān)節(jié)發(fā)出相應(yīng)響聲后來(lái)確定完成,。但是這種方法長(zhǎng)期來(lái)說(shuō)并沒(méi)有確切的效果,。

Traction is also a common treatment for degenerative disc problems. Traction gently stretches the low back joints and muscles. Patients are also shown stretches to help them move easier and with less pain.

      牽引則是另外一個(gè)常用的手段，緩慢柔和的牽引腰部可以有效緩解疼痛和恢復(fù)正?；顒?dòng)性,。

As you recover, you will gradually advance in a series of strengthening exercises for the abdominal and low back muscles. Working these core muscles helps patients move more easily and lessens the chances of future pain and problems.

      在恢復(fù)過(guò)程中，你往往還需要接受一系列的拉伸練習(xí)來(lái)鍛煉你相關(guān)的肌肉,。核心肌群的鍛煉可以提高患者活動(dòng)能力并緩解疼痛,。

A primary purpose of therapy is to help you learn how to take care of your symptoms and prevent future problems. You’ll be given a home program of exercises to continue improving flexibility, posture, endurance, and low back and abdominal strength. The therapist will also discuss strategies you can use if your symptoms flare up.

      這些治療最主要的目的是讓你知道如何應(yīng)對(duì)現(xiàn)有的癥狀從而避免相關(guān)問(wèn)題的發(fā)生。在家中你也可以繼續(xù)做一些拉伸等鍛煉來(lái)保持腰部正常的力量和相關(guān)肌肉正常的功能,。理療師還會(huì)告訴你如果某些癥狀加重該如何做,。

After Surgery

術(shù)后康復(fù)

Rehabilitation after surgery is more complex. Some patients leave the hospital shortly after surgery. However, some surgeries require patients to stay in the hospital for a few days. Patients who stay in the hospital may visit with a physical therapist in the hospital room soon after surgery. The treatment sessions help patients learn to move and do routine activities without putting extra strain on their backs.

      手術(shù)后的康復(fù)治療將會(huì)更加復(fù)雜。一些患者術(shù)后需要住院一段時(shí)間,，有些則很快出院,。那些術(shù)后留在醫(yī)院的患者往往需要接受理療師的指導(dǎo)來(lái)幫助患者在術(shù)后如何在避免給予脊柱過(guò)大應(yīng)力的基礎(chǔ)上去做一些常規(guī)的活動(dòng)。

During recovery from surgery, patients should follow their surgeon’s instructions about wearing a back brace or support belt. They should be cautious about overdoing activities in the first few weeks after surgery.

      在術(shù)后,，患者往往需要聽(tīng)從醫(yī)生的指導(dǎo)佩戴腰圍等護(hù)具,。在術(shù)后最初的幾周應(yīng)該注意避免過(guò)度運(yùn)動(dòng)。

Many surgical patients need physical therapy outside of the hospital. Patients who’ve had lumbar fusion surgery normally need to wait up to three months before beginning a rehabilitation program. They typically need to attend therapy sessions for eight to 12 weeks and should expect full recovery to take up to six months.

      很多術(shù)后病人在出院后仍然需要繼續(xù)接受理療,。腰椎融合術(shù)的患者往往需要至少三月以后再接受康復(fù)治療,。在術(shù)后三月后這些患者至少需要8-12來(lái)進(jìn)行康復(fù)，如果需要徹底康復(fù)則需要將康復(fù)治療時(shí)間延長(zhǎng)至六個(gè)月,。

（夏冬冬    譯）

夏冬冬,，同濟(jì)大學(xué)附屬上海東方醫(yī)院 脊柱外科博士，美國(guó)布萊根婦女醫(yī)院/哈佛大學(xué)醫(yī)學(xué)院博士后,，國(guó)際FOP（進(jìn)行性骨化癥）協(xié)會(huì)科研項(xiàng)目負(fù)責(zé)人,。

患者指南，圖文并茂,，

分門別類,，構(gòu)思巧妙。

深入淺出,，中英對(duì)照,，

醫(yī)患攜手,，共同探討。

能力有限,，時(shí)間倉(cāng)促,，

錯(cuò)誤難免，誠(chéng)惶誠(chéng)恐,。

懇請(qǐng)各位,，留言指導(dǎo)，

以利再版,，更加周到,。