Discectomy/Partial Discectomy

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 goal of surgery is to make the herniated disc stop pressing on and irritating the nerves, causing symptoms of pain and weakness.

The most common procedure is called a “discectomy” or “partial discectomy,” in which part of the herniated disc is removed.

Surgery

The goal of surgery is to make the herniated disc stop pressing on and irritating the nerves, causing symptoms of pain and weakness. The most common procedure is called a “discectomy” or “partial discectomy,” in which part of the herniated disc is removed. In order to see the disc clearly, sometimes it is necessary to remove a small portion of the lamina, the bone behind the disc. Bone removal may be minimal (hemi-laminotomy) or more extensive (hemi-laminectomy). Some surgeons use an endoscope or microscope in some cases.

Discectomy can be done under either local, spinal or general anesthesia. The patient lays face down on the operating table, generally in a kneeling position. A small incision is made in the skin over the herniated disc and the muscles over the spine are pulled back from the bone. A small amount of bone may be removed so the surgeon can see the compressed nerve. The herniated disc and any loose pieces are removed until they are no longer pressing on the nerve. Any bone spurs (osteophytes) are also taken out to make sure that the nerve is free of pressure.

In order to see the disc clearly, sometimes it is necessary to remove a small portion of the lamina, the bone behind the disc. Bone removal may be minimal (hemi-laminotomy) or more extensive (hemi-laminectomy). Some surgeons use an endoscope or microscope in some cases.

Any bone spurs (osteophytes) are also taken out to make sure that the nerve is free of pressure.