Degenerative disc disease can arise at any vertebral level. It occurs when the intervertebral disc decays and loses its mechanical strength. Eventually, the interior portion of the disc protrudes or herniates through the outer portion of the disc, making a bulge. The bulge can push into the space occupied by the spinal nerves or spinal cord. If the bulge compresses these neural tissues, it can produce a variety of debilitating symptoms, including pain.
Discectomy Surgery
Discectomy surgery is usually recommended when nonsurgical options have failed or when neurological symptoms have become debilitating, according to the Mayfield Clinic, a large neurosurgical practice located in Cincinnati, Ohio. Both open surgery and minimally invasive surgery using endoscopic techniques can be used. The goal of surgery is to remove the pressure on the neural tissues resulting from the herniated disc. This can be achieved either by removing the entire disc or by cutting away its bulging section.
Surgery can be approached from the anterior or posterior aspect of the body, depending on which spinal level and the specific procedure required, according to the American Academy of Orthopaedic Surgeons. Often, removal of the disc results in instability of the vertebrae. In addition, sometimes multilevel discectomy is needed. In these instances spinal fusion can be performed to achieve stability of the vertebral column. This normally requires grafting bone material into the disc space and then immobilizing the vertebrae with hardware, such as screws and plates. The patient usually can return to work in two to six weeks.
Disc Replacement Surgery
Artificial intervertebral disc arthroplasty is a new treatment for degenerative disc disease. According to the Blue Cross and Blue Shield Association, this method is nearly identical in the surgical procedures required for discectomy. The difference is that using an artificial disc eliminates the need for fusion and fixed hardware stabilization. Fusion requires that two or more vertebral bones grow together, filling in the space left by the disc. When fusion occurs, it can result in biomechanical problems above and below the fused segments, leading to adjacent-level degenerative disc disease. With disc replacement, the vertebral segments are free to move as they would normally, avoiding the development of subsequent pathology as a result of the fixation and altered biomechanics. Artificial intervertebral disc arthroplasty is associated with a host of strict eligibility criteria, according to BCBSA.
Nonsurgical Treatments
According to AAOS, nonsurgical treatment is effective in relieving pain and other symptoms in over 90 percent of patients. AAOS states that such treatments are most often sought before surgery is considered. Each patient and treatment plan is different, depending on the patent's needs. According to Cedars-Sinai, specialty treatments such as physical therapy, pain management, physiatry and alternative medicine can be used for pain reduction and to enhance mobility. Other treatments such as corticosteroid injections into the spinal column for pain relief, use of back braces, activity modification, electrotherapy and stress management can be employed.
