Abstract
The multiplicity of factors that influence the clinical evolution of discopathies, determine a great diversity in its presentation.
The barely known genetic predisposition, the individual morphological aspects, the age and sex, the associated co-morbidities as well as the patient environment define in its all an individual context that influences decisively the treatment for each patient.
On the other hand, the identification in each case of the different stages of the multilevel DDD, causes doubts regarding the involvement of each segment in the respective clinical condition.
To singly identify all sources of pain, and not only each painful level, is the main challenge poised to the spine surgeon when defining the treatment strategy.
The diagnosis aggressiveness must be proportional to its doubts, and the discography, the disco-scanner and the facet blocks are fundamental when the conventional clinical investigation is inconclusive.
The use of minimal invasive techniques such as IDET or Coblation can be considerate as alternatives, especially in the early stages of single-level DDD.
The nucleoplasthy – nuclear prosthesis- is an interesting alternative in the intermediate stages of the discogenic pain DDD, as well as in the predominant facet pain or in the foraminal dynamic stenosis is the dynamic stabilization. Those are techniques with controversial results and which liability in some cases is yet to be proven.
Last, the use of different techniques in different levels in the context of multi-level DDD – ex: fusion + disc replacement; disc replacement + dynamic stabilization with or without decompression procedures in the spinal canal- must be rigorously considered according to the specific dysfunction of each segment and considering the anatomical and functional reconstruction of the spine.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
