Since degenerative disc disease can occur at more than one vertebral level, multi-level treatments must be applied. The pathology in multi-level degenerative disc disease begins when the discs lose their mechanical strength and begin to bulge or herniate. When the bulges protrude and impinge on the spinal roots or the spinal cord, then pain and other symptoms begin. All treatments aim at reducing the pressure on these neural tissues. Some involve noninvasive methods. while surgery is the only method aimed directly at permanently removing the bulges.
Discectomy
When nonsurgical options fail to relieve pain and other neurological symptoms, and when those symptoms become incapacitating, then surgical discectomy is usually recommended, according to the Mayfield Clinic. Two types of surgery can be used: open and minimally invasive. Both require endoscopic methods. The objective of surgery is to eliminate the compression of the discs on the neural tissues that cause the symptoms. This can occur with removal of part or the entire intervertebral disc at the involved segments.
According to the American Academy of Orthopaedic Surgeons, the surgical approach is either from the front or the back of the spine, depending on the levels of involvement and the specific procedure needed. When multiple discs are removed, the result can be an unstable spine and, in this circumstance, the vertebral column is stabilized by multi-level fusion. Fusion requires bone material to be grafted into the intervertebral disc spaces. Then the vertebrae are immobilized using metal hardware such as plates and screws. Patients can normally resume work in two to six weeks.
Disc Replacement
A new treatment for multi-level degenerative disc disease is artificial intervertebral disc arthroplasty. This method, according to the Blue Cross and Blue Shield Association is practically identical to the surgery needed for discectomy. The main difference is that with artificial intervertebral disc arthroplasty there is no need to fuse the vertebral bones. There also is no need for permanent fixation hardware. These are significant advantages because they eliminate complications from hardware as well as the biomechanical stresses of fused bones. This means that when fusion occurs, the segments above and below the fusion are under greater stress, which can result in additional degenerative disc disease, according to BCBSA. With artificial intervertebral disc arthroplasty, all segments are free to move naturally, thereby minimizing additional pathology. Also, according to BCBSA, artificial intervertebral disc arthroplasty is associated with many stringent eligibility restrictions.
Noninvasive Treatments
AAOS states that noninvasive, or conservative, treatments are 90 percent effective in relieving pain and other symptoms of degenerative disc disease. AAOS also states that noninvasive treatments should be sought before considering surgery. Depending upon the patient's needs, a treatment plan is designed to minimize pain and increase mobility. Cedars-Sinai states that such treatments include pain management, physical therapy, physiatry and alternative medicine. Also, specific techniques can be used, which include injecting corticosteroids into the spinal column for pain relief, using back braces, electrotherapy, modifying patient activities and stress management.
