Lumbar Degenerative Disc Disease腰椎间盘退变性疾病 A Patient’s Guide to Lumbar Degenerative Disc Disease腰椎间盘退变性疾病患者指南
Treatment治疗
What treatment options are available? 有哪些治疗可供选择？ Nonsurgical Treatment保守治疗
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. 如果条件允许，医师们都偏向选择保守治疗而非选择手术治疗。保守治疗最主要的目的是缓解患者的疼痛从而尽早恢复患者的日常活动。 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. 医生们很少让有椎间盘退变问题的病人卧床休息，相反医生们往往鼓励患者继续日常活动，并以疼痛作为活动强度的衡量标准。如果疼痛确实非常严重，最多给予患者休息两天的处理。
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. 腰围往往会被使用，因为它可以有效稳定腰椎从而缓解疼痛。当医生建议使用腰围的时候，他们往往会嘱咐患者最多使用2-4天，以防止产生对腰围的依赖，引起相关肌肉的萎缩。
Patients may also be prescribed medication to help them gain control of their symptoms so they can resume normal activity swiftly. 患者往往还会接受药物治疗，从而缓解疼痛，让患者可以继续日常的活动。
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. 如果症状持续恶化，医生往往建议硬膜外激素注射治疗（ESJ）。类固醇类激素是强力的抗炎药物，可以有效缓解肿胀和疼痛。ESJ的机制是将类固醇类药物注射到腰椎神经根附近。有些医生仅仅使用类固醇，而大多医生会选择结合使用长效局麻药。总体来说，ESJ仅仅在其他保守治疗都无效的情况下使用，而ESJ并不总能有效，如果有效往往也是暂时的。
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. 在相关药物治疗的同时，患者往往还需要接受康复治疗。在评估相关情况后，康复师会指导患者进行一系列的姿势和练习来缓解症状。康复师会设计一套锻炼方案以提高紧张肌肉的柔韧性，增强背部和腹部肌肉的力量，帮助患者安全地活动，减少疼痛的发生。 Surgery手术治疗 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. 椎间盘退变性疾病随着时间的推移会逐渐加重。大多数的患者不需要接受手术治疗。事实上，椎间盘退变性疾病的患者通常只有1%~3%需要手术治疗。 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 医生往往会先选择三个月的保守治疗，在保守治疗无效后才会考虑手术治疗，主要的手术方式是： · lumbar laminectomy · discectomy · fusion · 腰椎椎板切除术 · 椎间盘切除术 · 融合术
腰椎椎板切除术 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，像根状结构横跨在椎管上。当椎管内神经被退变的椎间盘或者骨刺挤压时，椎板的切除可以有效缓解相关神经所受到的压力。 Related Document: A Patient’s Guide to Lumbar Laminectomy 相关阅读： 腰椎椎板切除术患者指南（翻译招募中，有兴趣者请留言） Discectomy 椎间盘切除术
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). 通过手术方式切除部分或者全部椎间盘称为椎间盘切除术，它往往用于切除那些已经突出或脱出并压迫脊神经的椎间盘组织。脊柱外科医师往往会从患者后背切一个小口，部分切除椎板后，切除相关椎间盘这叫做椎板开窗单纯髓核摘除术。切开的椎板将会提供足够的操作空间来切除相应椎间盘。
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. 许多脊柱外科医生现在更偏好于微创手术即通过背部的一个小创口来切除已经损伤了的椎间盘组织。提倡这种术式的医生认为微创手术更加简单而且可以有效防止神经和关节的疤痕组织形成，更容易恢复。微创手术包括：经皮椎间盘切除术，激光椎间盘切除术，显微椎间盘切除术。 Related Document: A Patient’s Guide to Lumbar Discectomy 相关阅读：椎间盘切除术患者指南（翻译招募中，有兴趣者请留言） Fusion 融合术 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. 融合术是指将两个或多个骨性结构融合从而避免骨性结构见的微动。融合术有时往往会伴随着椎间盘的切除术。原先活动的骨性结构融合后可以有效解除疼痛和炎症。 The main types of fusion for degenerative disc problems include · anterior lumbar interbody fusion · combined fusion 治疗退变性椎间盘疾病主要的融合方法主要包含： 腰椎后路融合术 前后路联合融合术 Anterior Lumbar Interbody Fusion 腰椎前路融合术
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. 前路腰椎椎体间融合术是经腹腔入路到达椎体前缘，从而得到有效手术空间切除相应椎间盘。在相应椎体间植入骨块。有两种方式：一种直接植入切自于骨盆的植骨块。第二种植入两枚结合骨块的钛合金螺钉即融合器。植骨块和上下椎体融合后，整个节段将会被固定。 Related Document: A Patient’s Guide to Anterior Lumbar Fusion with Cages 相关阅读：腰椎前路椎体间融合术患者指南（翻译招募中，有兴趣者请留言） Posterior Lumbar Fusion 腰椎后路融合术
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. 腰椎后路融合术通过腰椎背部入路，在手术中脊柱外科医师会将小骨粒铺在相关节段的椎体后部，从而达到融合。很多医生还会同时给予金属钉板系统来帮助还没融合前固定相应节段，使融合更好更快。 Related Document: A Patient’s Guide to Posterior Lumbar Fusion 相关阅读：脊柱后路融合术患者指南（翻译招募中，有兴趣者请留言）
Combined Fusion 前后路联合融合术
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. 腰椎前路椎体间融合术将脊柱相关节段前后部分都融合。许多医师认为通过前后固定植骨块可以更有效固定并可以防止植骨块的塌陷，一些研究也确实证实了这一点。
Rehabilitation康复治疗 What should I expect as I recover? 当我恢复后预期能达到什么样的目标？ Nonsurgical Rehabilitation非手术康复治疗 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. 你的医生往往会建议你接受连续4-6周、每周多次的康复治疗，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. 康复治疗的最主要目的是缓解症状。康复医师往往会帮助你找到可以缓解疼痛的体位和运动，他们还会使用热疗，冰敷，超声波和电刺激来缓解肌肉的疼痛和痉挛。 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. 理疗师还喜欢使用按摩推拿等手段来活动相关软组织从而可以缓解相应疼痛。这种脊柱的理疗可以让椎间盘退变性疾病得到短时间的缓解。有部分人认为这种脊柱推拿术可以重制神经和肌肉的敏感度，从而可以缓解疼痛恢复正常的活动性。这种推拿往往伴随着强力的拉伸并以相应关节发出相应响声后来确定完成。但是这种方法长期来说并没有确切的效果。 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. 牵引则是另外一个常用的手段，缓慢柔和的牵引腰部可以有效缓解疼痛和恢复正常活动性。 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. 在恢复过程中，你往往还需要接受一系列的拉伸练习来锻炼你相关的肌肉。核心肌群的锻炼可以提高患者活动能力并缓解疼痛。 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. 这些治疗最主要的目的是让你知道如何应对现有的症状从而避免相关问题的发生。在家中你也可以继续做一些拉伸等锻炼来保持腰部正常的力量和相关肌肉正常的功能。理疗师还会告诉你如果某些症状加重该如何做。 After Surgery术后康复
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. 手术后的康复治疗将会更加复杂。一些患者术后需要住院一段时间，有些则很快出院。那些术后留在医院的患者往往需要接受理疗师的指导来帮助患者在术后如何在避免给予脊柱过大应力的基础上去做一些常规的活动。 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. 在术后，患者往往需要听从医生的指导佩戴腰围等护具。在术后最初的几周应该注意避免过度运动。
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. 很多术后病人在出院后仍然需要继续接受理疗。腰椎融合术的患者往往需要至少三月以后再接受康复治疗。在术后三月后这些患者至少需要8-12来进行康复，如果需要彻底康复则需要将康复治疗时间延长至六个月。 （夏冬冬 译） 夏冬冬，同济大学附属上海东方医院 脊柱外科博士，美国布莱根妇女医院/哈佛大学医学院博士后，国际FOP（进行性骨化症）协会科研项目负责人。 患者指南，图文并茂， 分门别类，构思巧妙。 深入浅出，中英对照， 医患携手，共同探讨。 能力有限，时间仓促， 错误难免，诚惶诚恐。 恳请各位，留言指导， 以利再版，更加周到。 |
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