Surgery for Degenerative Disc Disease

Written by Jason M. Highsmith, MD

When diagnosed with degenerative disc disease, one of the first things that many patients ask is, "Am I going to need surgery to fix this?" For the majority of people, the answer is no. You actually have to meet some rather stringent requirements in order for your doctor to recommend surgery:

Surgery may be required immediately if you have one of these red flags:

In-depth Articles on Degenerative Disc Disease Non-surgical Treatments

Traditional Surgical Options for Degenerative Disc Disease
Up until recently, surgery for degenerative disc disease has involved two main components: removal of what's causing pain and then fusing the spine to control movement. When the surgeon removes tissue that's pressing on a nerve, it's called a decompression surgery. Fusion is a stabilization surgery, and often, a decompression and fusion are done at the same time.

Traditional decompression surgical options include:

All of the above decompression techniques are done from the back of the spine (posterior). Sometimes, though, a surgeon has to do a decompression from the front of the spine (anterior). For example, a bulging disc or a herniated disc pushing into your spinal canal sometimes cannot be removed from behind because the spinal cord is in the way. In that case, the decompression procedure is usually performed from the front (anterior). The main anterior decompression techniques are:

After part of a disc or vertebra has been taken out, your spine may be unstable, meaning that it moves in abnormal ways. That makes you more at risk for serious neurological injury, and you don't want that. The surgeon will need to stabilize your spine. Traditionally, this has been done with a fusion, and it can be done from the back (posterior) or from the front (anterior).

In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability as the bones fuse. The fusion will stop movement between the vertebrae, providing long-term stability.

New Surgical Option for Degenerative Disc Disease
A successful fusion limits movement in the fused area. Now there's a new surgical option that helps you maintain mobility: an artificial disc. The surgeon will remove your disc (a discectomy), and then insert an artificial disc in its place. The idea is that the artificial disc will keep your spine flexible and help you move more easily and with less pain.

Artificial discs are very new, but they're a fascinating development in spine surgery. However, because they're so new, there haven't been many long-term studies in the US about the effectiveness of artificial discs. Short-term studies and studies from Europe are promising, though.

Surgical Risks
As with any operation, there are risks involved with spine surgery for degenerative disc disease. Your doctor will discuss potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:

Complications could lead to more surgery, so again—make sure that you completely understand your surgery and the risks before proceeding. The decision for surgery is yours and yours alone.

Recovery from DDD Surgery
After surgery for DDD, you won't immediately feel better. If you've had a fusion, it will take some time (several months or longer) for the fusion to heal properly, and in the meantime, you could have pain in the area where you had surgery. Your incisions should heal in 7 to 14 days.

Your surgeon will give you specific instructions on what you can and can't do following surgery. Be sure to stick with the recovery plan and not overdo it or overstress your spine. Report any problems—such as fever, increased pain, or infection—to your doctor right away.

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