When is it Right to Have Surgery for Degenerative Disc Disease?
Deciding whether or not to have surgery for degenerative disc disease is an elective decision. No one ever died from having severe degenerative disc disease (DDD), so in that regard it is similar to arthritis.
Who gets DDD? Typically it is patients between the ages of 25 to 60. During those years, the disc spaces begin to lose fluid and as a result, the disc may experience some fraying and loss of height. If the outer portion of the disc experiences irritation from these issues, it may hurt. The only part of the disc that contains nerve endings and is able to feel pain is the outer portion, which is called the annulus fibrosus.
When patients are suffering from degenerative disc disease, the nonsurgical options consist of:
1. Benign neglect
2. Physical therapy
3. Chiropractic Treatment
4. Spinal Decompression Treatment
5. Interventional Pain Management
6. Pain Medication
7. Bracing and TENS units
Nonsurgical therapies work well over seventy five percent of the time. Individuals are often able to end up in an acceptable state of pain control and can avoid surgery. One of the most successful treatments that has been shown in the literature is aerobic exercise. This could include cycling or swimming.
If a person attempts significant conservative treatment for over 6 months with the pain still present, it could be time to start considering surgery. The North American Spine Society recommends minimum six months of nonsurgical treatment first, and maybe more since it could take that long to start getting results. A surgical decision should be heavily debated. A discogram may help prior to the procedure for DDD although it is highly debated. This procedure can tell if the disc is the pain generator.
If the person has one level that tests positive on the discogram procedure and all imaging studies also point to that identical level as having substantial degeneration, then surgery may have a high level of success. In fact, it may be a life changing procedure. But this is not always the case as even if the diagnosis is presumed and a technically proficient surgery is undertaken, the outcome may end up in residual pain. Getting rid of one hundred percent of a person’s back pain is typically not possible. One should expect with a one level DDD and a great surgery performed to be able to get rid of 50 to 75% of a patient’s pain.
Surgery for DDD currently consists of 2 options. One is an artificial disc replacement, the other is a spinal fusion. Back in 2004, the FDA approved artificial disk replacement for the lumbar spine, and the hope is it would be a revolutionary procedure for DDD. So far, that has not been the result. Results for the procedure have been about 70% good to excellent.
However artificial disc surgery has not shown superiority yet to spinal fusion. Neither artificial disc nor spinal fusion has a success rate of ninety percent (closer to 70%), individuals should consider it heavily prior to surgery.
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