Conservative treatment of senile spinal diseases: drug therapy and nerve block

As we get closer to super-aged society, the prevalence of senile spinal diseases is constantly increasing and the burden on individuals and society grows high. Senile spinal disease is basically degenerative in nature. Pain and physical dysfunction occur due to various complex pathologic causes. For the diagnosis and treatment of such complex diseases, it is essential to understand common senile spinal diseases such as intervertebral disc herniation and spinal stenosis. Degenerative changes in intervertebral discs are caused by a combination of aging and excessive physical load, which results in structural damages and molecular biological changes in the intervertebral discs. Spinal stenosis is a disease in which nerves and blood vessels are compressed by hypertrophied ligamentum flavum, bulged disc, and a hypertrophied facet. Ligamentum flavum hypertrophy, which is the most important etiology in spinal stenosis, occurs due to mechanical stress and a cascade of inflammation and fibrosis reactions. Drug therapy targeting these pathologic mechanisms includes non-steroidal anti-inflammatory drugs, antidepressants, anticonvulsants, and agents that improve blood circulation. Nerve blocks, which prevent these pathophysiologic conditions, are also a good treatment modality. Typical nerve block techniques include medial nerve block and epidural block. It is necessary to understand the pathophysiology of senile spinal diseases and establish an appropriate treatment strategy that suit the patient's condition.