Degenerative Disc Disease: Treatment Beyond Six Weeks

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Degenerative Disc Disease (DDD) is a gradual process that may compromise the spine. What should patients expect during the first six weeks and, if necessary, beyond? That is the focus of this article.

First Six Weeks
Usually during the first six weeks, acute low back pain is treated with a couple of days of bed rest (slightly longer with a herniated disc) and appropriate medication. Muscle relaxants are seldom used for longer than one week. Early ambulation is encouraged to increase circulation (aids healing), improve flexibility, and build strength.

Generally, during the first two to three weeks, acute symptoms subside. Aerobic (no/low impact) exercise may be started three times per week along with daily back exercises. Some patients may be referred to physical therapy or a supervised work-conditioning program.

Beyond Six Weeks
If the symptoms of degenerative disc disease and low back pain persist despite non-operative treatment, further diagnostic tests may be necessary. These tests may include an MRI, CT Scan, myelogram, or possibly discography.

Although most degenerative disc disease patients with herniation respond well to non-surgical treatment, a small percentage do not. Disc herniation is the most common indication for spinal surgery. In fact, 75% of all spinal surgeries are for a herniated disc.

Red Flags

• Lumbar (low back) herniation causing loss of bowel or bladder control, or major lower extremity deficit, requires immediate surgery. These symptoms (Red Flags) are caused by nerve root compression.

• Cauda Equina Syndrome is a serious disorder that may be caused by a large central herniation. The cauda equina begins at the end of the spinal cord. The cauda sac is filled with nerves resembling the tail of a horse. When this sac is compressed the patient may present with the following symptoms: low back pain, bilateral lower extremity weakness, radiculopathy (pain from a nerve root), and incontinence.

When these symptoms present, surgery is required immediately. Most herniated discs often do not require surgical intervention and respond quite nicely to non-surgical treatments (within 6 weeks).

Surgical Procedures
The type of surgical procedure depends on the patient, the diagnosis, and the treatment goals.

Surgical removal of a disc may involve a limited laminotomy and partial disc excision. The disc fragments are removed and the nerve is decompressed. Microdiscectomy is often a preferred procedure requiring smaller incisions. Benefits include smaller scars and a faster recovery.

If the entire disc is removed, fusion may be needed to stabilize the spine. Patients who are obese, smoke, or who have psychological problems experience lower rates of success. Smoking in particular negatively impacts the process of fusion and healing in general. Spinal fusion may be combined with spinal instrumentation (e.g. screws, cages).

In Conclusion
Although degenerative disc disease is relatively common in aging adults, it seldom means spine surgery. When medical attention is needed, most patients respond well to non-surgical treatment. If people stop smoking (all tobacco use), keep up with a regular fitness program and good diet, most can enjoy the benefits of a healthy spine.