Rest, ice, compression and elevation of the joint is the first step in the treatment. Nonsteroid anti-inflammatory drugs and dietary supplements are recommended. If severe effusion and loose body is present arthroscopic removal and treatment of the damage may be necessary. Arthroscopy is also useful for the assessment of the cartilage lesion as the extent of the affected area and its relation to other lesions (mirror or kissing lesions) is crucial in the decision for treatment option. Similar chondral defects in adolescent and adult patients have a lot worse expectation for spontaneous healing than the young ones. The usually applied cartilage repair methods would be (depending mostly on the size of the lesion): microfracture, mosaicplasty, cartilage cell implantation or large allograft implantation.
CT is the investigation of choice for the diagnosis. The scans not only show that the collection within the spinal canal is composed of gas but also provide useful information on the condition of the disc and of the rest of the lumbar spine. The typical findings include degenerative disc disease with central vacuum phenomenon and, at the same level, a collection of epidural gas in contact with the nerve root corresponding to the distribution of the pain. This last point is important because epidural gas is sometimes present in asymptomatic patients. The gas collection can range in size from a few millimeters to 1 centimeter and in density from – 200 to – 900 Hounsfield units. Rim enhancement can be seen. MRI yields similar findings, with low signal on T1- and T2-weighted images and postgadolinium rim enhancement [ 12 ].
NSAIDS with preferential cyclo-oxygenase 2 inhibitions have been developed. These include: