Degenerative disk disease can produce pain and other functional deficits. The disease produces small defects in the outer wall of the intervertebral disk. When the disk is pressurized by the force of the vertebrae, these defects allow softer material from the disk's interior to squeeze through. The result is a physical bulge on the disk, and symptoms occur when it pushes on adjacent neural tissues.
Conservative Treatments
Conservative or non-surgical treatments are over 90 percent successful in alleviating symptoms in patients with degenerative disk disease, says the American Academy of Orthopedic Surgeons. Such treatments should be tried before surgery is considered according to the needs of the patient. Spine-Health says such treatments should include rest, physiatry, physical therapy, alternative medicine and pain management. The goal is to reduce pain and enhance mobility. Other treatments can include intra-spinal steroid injections, orthotics, electrotherapy and activity modification.
Traditional Discectomy
Discectomy surgery is the traditional surgical procedure usually recommended when conservative options have failed or when sensory and motor symptoms have worsened, according to the American Academy of Orthopedic Surgeons. Either open or minimally invasive surgery techniques can be used to remove either the entire disk or small pieces. Depending on the level of involvement and the amount of disk material requiring removal, surgery is approached from the front or back of the spine, according to the academy. Sometimes discectomy requires fusing the vertebrae. This can be achieved by grafting bone material into the intervertebral space and then stabilizing the vertebrae with metal hardware. Normally, patients go back to work in fewer than six weeks.
Disk Replacement Surgery
A new surgical therapy for degenerative disk disease is artificial intervertebral disk arthroplasty. The BlueCross BlueShield Association says this method eliminates the need for fusion and fixation hardware. Also, the replacement disk enables the spine to move naturally, eliminating the stiffness resulting from fused vertebrae. It's thought that this flexibility eliminates the development of disk disease at adjacent levels. The procedure is nearly identical to that used for a traditional discectomy. There also are many strict eligibility criteria for this procedure.
Candidates for Artificial Disk
The best candidates for artificial disk replacement are patients who have tried one or more conservative treatments for at least six months but failed. CoastalSpine suggests that the most qualified patients are those who have single disk disease between L4 and L5 or between L5 and S1, where the disks are worn out and who have resultant pain. Other candidates for this procedure are patients with degenerative disk disease and in which the vertebrae have moved less than 3mm. Other factors to consider are the patient's level of activity, weight, occupation and allergies.
Risks of Surgery
All surgery has associated risks. Spine-Health says the specific risks associated with a discectomy include damage to the trachea, esophagus or blood vessels in cervical spine surgery due to the use of retractors. Temporary hoarseness also can result if the laryngeal nerve is damaged. While rare, damage to the spinal cord or spinal nerves can result in sensorimotor deficits. Perhaps the most common problem, according to Spine-Health, is non-union or failure of the vertebrae to fuse. This happens in about 5 percent of cases and may require another surgery. Other risks include cerebrospinal fluid leakage and tissue abrasion by the hardware or hardware fracture, including fracture or dislocation of an artificial disk.
