Disc Replacement Surgery

Degenerative disc disease is one of the most common causes of low back pain and neck pain, and also one of the most misunderstood.

For a patient who are new to this diagnosis, common questions often include:

  • If I have pain from degenerative disc disease in my thirties, how much worse will it become with age?
  • Will the degenerative disc disease become a crippling condition? Will I end up in a wheelchair?
  • Should I restrict my activities? Can I still play sports?
  • Will the disease spread to other parts of the spine?
  • Will the degenerated disc(s) cause any permanent damage?
  • What can I do to reduce the symptoms from a degenerated disc?
  • Is surgery inevitable?

Simply put, degenerative disc disease describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine.

While the definition sounds simple, many patients diagnosed with degenerative disc disease are left wondering exactly what this diagnosis means for them.

Cause

Generally, the pain associated with degenerative disc disease is thought to stem from two main factors:

Inflammation

The proteins contained within the disc space can cause a lot of inflammation, and as a general rule inflammation will cause pain.

In the lumbar disc space, the low back pain can radiate into the hips. The associated pain can also travel down the back of the leg (also called sciatica, or radiculopathy), and possibly into the foot and toes.

In the cervical disc space, the neck pain may be local or may radiate into the arm, shoulder and possibly into the hand (a cervical radiculopathy).

Treatment

The common course of symptoms for people with degenerative disc disease is symptoms that flare up periodically, but overall the symptoms don’t progress over time.

DDD Treatment Goals

For people with painful flare-ups, the main treatment goals will usually include:

Pain Control

The focus of this part of treatment is on achieving enough pain reduction to enable the patient to pursue a specific exercise and rehabilitation program. Pain from a degenerated or collapsed disc is usually caused by both instability and inflammation, so both of these causes of pain should be addressed.

For most people treatment is nonsurgical and may include one or a combination of many medical, alternative, and/or self care approaches. Often a patient needs to take a trial and error approach to find which types of treatment work best.

The operative solutions, a fusion or artificial disc, are extensive surgeries and patients are usually advised to make a serious effort with nonsurgical treatments for at least 6 months prior to considering surgery.

Surgery

Disc Replacement

This procedure involves removing the disc and replacing it with artificial parts, similar to replacements of the hip or knee.

The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion.

Cervical Disc Replacement Surgery

The standard surgical procedure for a disc replacement is an anterior (from the front) approach to the cervical spine. This surgical approach is the same as that presently used for a discectomy and fusion operation. The affected disc is completely removed including any impinging disc fragments or osteophytes (bone spurs). The disc space is distracted (jacked up) to its prior normal disc height to help decompress (relieve pressure) on the nerves. This is important because when a disc becomes worn out, it will typically shrink in its height, which can also contribute to the pinching on the nerves in the neck.

Lumbar Disc Replacement Surgery

Lumbar disc replacement is similar to other types of joint replacement (such as hip and knee replacements). The concept is similar in that the surgeon is removing a damaged joint, and replacing this with a metal and plastic implant. In the lumbar spine, the goal is to remove the damaged, painful disc, and replace this with a metal and plastic implant. The implant is designed to move like a normal disc.

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