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Degenerative Disc Disease Treatments

Is Surgery Your Best Option?

Question: I have degenerative disc disease at C5-C7. I'm going to have a cervical epidural steroid injection to see if that helps relieve my pain, but my doctor told me that it would be beneficial to have the surgery to fuse the damaged discs and vertebrae. He gave me lots of surgery options, including using an artificial replacement disc, but now I'm just confused. How do I know which surgery is best for me?
—Richmond, VA

Answer: While I can't exactly tell you which surgery is best for you, I can offer you some guidance that can help you make your decision on whether to have surgery for degenerative disc disease (DDD).

Before going straight to the operating table, consider more conservative (non-surgical) treatments. You mentioned that you're going to have a cervical epidural steroid injection—a non-surgical treatment that uses steroids to help decrease inflammation of your spinal nerve roots.

Some people who have epidural steroid injections experience pain relief for a few weeks, while others have pain relief for months. See how the cervical epidural injection works for you. It may work so well that you decide that surgery maybe isn't the best option for you at this time.

In addition to epidural steroid injections, many patients who have DDD have also found non-surgical pain relief with:

  • physical therapy
  • medications
  • exercise
  • chiropractic treatment
  • alternative treatments, such as acupuncture

Of course, you should work closely with your doctor to determine the best DDD treatment options for you. You may need a combination of different treatments to relieve your pain.

As for the surgery options your doctor gave you: Yes, it can be incredibly overwhelming at first to decide what type of surgery you should have or if you should even have surgery in the first place. It's best to research all your surgery options and ask your doctor questions.

The 2 surgery options you mentioned—fusion and artificial disc replacement—help restore disc height and relieve pressure on your nerves and thus reducing your pain. Since you have DDD at C5-C7, that means the last 3 vertebrae in your cervical spine (neck) have degenerated.

With fusion surgery, your doctor will perform a discectomy so he or she can fuse your vertebrae and then use bone graft (usually bone taken from a donor's body) or, more commonly, a plastic spacer filled with a special material to facilitate the fusion process. Fusion surgery is commonly performed in the neck and low back.

With artificial disc replacement, your degenerated disc is removed and replaced with an implant, usually made of metal and polyethylene, a type of plastic that's very similar to the material used for hip and knee replacements. Although artificial disc replacement was approved several years ago, it has recently become more popular.

Ultimately, what type of surgery you have will depend on several factors, including:

  • your symptoms: These can determine what type of surgery you can have. For example, if you have radicular pain (shooting pain) down your arm, artificial disc replacement might be the best option for you.
  • the type of pain you have: Many patients need decompression surgery (removing pressure from the nerves) to relieve nerve pain. Decompression surgery can help treat your numbness and weakness. However, if a lot of bone needs to be removed, then fusion surgery may be a better option.
  • your age: The older you are, the more likely you are to have disc degeneration. That's because over time, your discs wear down and become weak. This is caused by normal wear and tear, but any type of trauma—even if it's minor—can accelerate this process.
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