Degenerative Disc Disease

When is it Time to Consider Surgery?

intervertebral disc in the spineFor most people (especially those who haven’t spent countless hours researching back pain relief remedies) the most basic understanding of the spine is that it is made up of a number of vertebrae stacked atop one another. And while this is true, this incredible structure in our bodies is far more complicated than just a few dozen bones in a row. You see, the space between each of those vertebrae is filled with a soft, shock absorbing structure called a disc. But perhaps most importantly, these flexible discs in the spine are what allow it (and you) to bend.

 Over time, these spinal discs can begin to break down, either through normal wear and tear or as the result of other factors. When this happens, the condition is called degenerative disc disease and it can cause severe pain. For the vast majority of people suffering from degenerative disc disease, physicians will first recommend a course of treatment that includes conservative (non-surgical) options.  Conservative treatments for degenerative disc disease are aimed at relieving pain and restoring motion and may include physical therapy, chiropractic treatments, injections or specific medications designed to reduce pain and inflammation.  When conservative therapy to resolve the pain is unsuccessful and the pain continues (usually for at least six months), surgery may be recommended.

Historically, the “Gold Standard” surgical treatment of degenerative disc disease has been spinal fusion. Spinal fusion is a surgical procedure that endeavors to remove damaged disc material and then permanently “lock” two or more of the spine’s vertebrae together so they are unable to move except as one fused unit. In a motion segment of the spine, the disallowing of movement is designed to eliminate pain.

While pain elimination is a critical goal in any surgical spine procedure, so too is the restoration of movement. For us spine surgeons, it isn’t enough that we reduce pain. We also want to restore your spine to as normal a range of motion as possible which is the basis for healthy and active living. A healthy and “normal” spine allows for movement at each of the discs. But fusing the spine does have some well-known disadvantages including the loss of motion and flexibility. Additionally, spinal fusion can increase the potential for other discs above and below the fused segment to be more burdened over time and to degenerate more quickly, thus leading to more pain and possibly, the need for future surgery.

To minimize these spinal fusion disadvantages and risks, another procedure has been developed. Artificial disc replacement surgery offers a viable alternative to the standard spinal fusion procedure in that it is reversible and directly replaces the damaged discs themselves, rather than fusing vertebrae together permanently. There are different types of artificial disc devices but the primary goal of each is to replace a failing disc while acting as part of the spine’s “normal” anatomy, thus eliminating pain and restoring a more normal range of spinal motion for the patient, often leading to a better quality of life down the road.

While artificial disc replacement can be a promising option for many patients, it isn’t right for everyone. For those who suffer from spondylolisthesis, osteoporosis, a previous spinal fracture and other conditions that may affect the strength and integrity of the spine, artificial disc replacement may not be an option. And with any surgical procedure, there are also risks involved with artificial disc replacement surgery. It is important to understand and discuss each of these risks with an expert spine surgeon as you weigh your options.