Surgical Interventions for Degenerative Disc Disease

When diagnosed with degenerative disc disorder, among the primary things that lots of patients ask is, “Am I going to need surgery to repair this?” For many people, the answer is no. You in fact need to meet some rather stringent demands in order for your doctor to recommend operation:

You have attempted several months—ordinarily about six months—of non-operative treatments, plus they haven’t helped reduce your pain. What this means is that you simply have attempted physical therapy, medications, rest, among others, and your pain is still interfering with your life.

Your disc degeneration is at two levels not just one. When you have multi-level disc degeneration, you might not be the best candidate for surgery as you may lose an excessive amount of mobility in your back if you have a fusion (that sort of surgery is clarified below).

You’re comparatively young. Recovery from operation could be a tough procedure, so that your body requires in order to manage it. Younger individuals are somewhat more effective at recovering than older folks that are more prone to complications from operation. There’s not a certain “you should not have surgery if you are older than this” age. Your physician will probably be able to create that recommendation.

Operation could be required immediately for those who have among these red flags:

• Loss in bladder or bowel control
• Cauda equina syndrome is an incredibly serious ailment. Your cauda equina—or “horse’s tail”—is several nerves that resembles, competently enough, a horse’s tail. It is situated at the conclusion of the spinal cord, and it is a surgical emergency when the cauda equina is compressed. You might have extreme low back pain, weakness in your legs, radiculopathy (pain that goes out of your back and into your legs), and incontinence.

Types of Surgery for Degenerative Disc Disease

Up until lately, surgery for degenerative disc disease has called for two main parts: removal of what’s causing pain and then fusing the back to control movement. When the surgeon removes tissue that’s pressing on a nerve, it is called a decompression surgery. Fusion is a stabilization surgery, and frequently, a decompression and fusion are done at the exact same time.

Traditional surgical options that are decompression include:

• Facetectomy: There are joints in your spine called facet joints; they help stabilize your back. Yet, facet joints can put pressure on a nerve. “Ectomy” means “removal of.” So a facetectomy involves removing the facet joint to reduce that pressure.
• Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it makes the vertebra (through an exit called the foramen), a foraminotomy might be done. “Otomy” means “to make an opening.” So a foraminotomy is making the opening of the foramen larger, therefore the nerve can depart without being compressed.
• Laminectomy: At the rear of every vertebra, there is a bony plate that protects your spinal canal and spinal cord; it’s known as the lamina. It may be pressing in your spinal cord, hence by removing section or all of the lamina, the surgeon may make more room.
• Laminotomy: Similar to the foraminotomy, a laminotomy makes a more substantial opening, this time in your bony plate shielding your spinal canal and spinal cord (the lamina). The lamina may be pressing therefore the surgeon may make more room for the nerves using a laminotomy.

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). As an example, a bulging disc or a herniated disc shoving 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 normally performed from the front (anterior). The main anterior decompression techniques are:

• Discectomy: It might be pressing on your own nerves in case you are in possession of a bulging disc or a herniated disc. In a discectomy, the surgeon will remove all or area of the disc. The surgeon can do a discectomy using a minimally invasive approach. Minimally invasive means that there are smaller incisions as well as the surgeon works with a microscope and very little surgical tools. You’ll possess a recovery period that is shorter when you possess a minimally invasive discectomy.
• Corpectomy (or Vertebrectomy): Occasionally, surgeons will need to take the complete vertebral body out because disc substance becomes lodged between the spinal cord and also the vertebral body and can’t be removed by a discectomy. In other cases, osteophytes form between spinal cord and the vertebral body. In these situations, the whole vertebral body may need certainly to be removed to gain access to the disc material that is pressing on your nerve—that’s a corpectomy.

After portion of a disc or vertebra continues to be taken out, your back could be shaky, meaning that it proceeds in strange ways. That makes you more at risk for serious neurological harm, and you don’t want that. The surgeon will need to stabilize your spine. Traditionally, this has been done using a fusion, and it can be done from the back (posterior) or in the front (anterior).

In spine stabilization by fusion, the surgeon creates an environment where the bones in your back will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (normally using bone from your own personal body, but it is possible to utilize 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 raise stability as the bones fuse. The fusion will cease movement between the vertebrae, providing long term stability.

New Surgical Options for Degenerative Disc Disease

A fruitful fusion restricts motion in the fused area. Now there’s a brand new surgical option that helps you keep freedom: an artificial disc. The surgeon will remove your disc (a discectomy), and insert an artificial disc in its area. The notion is that the artificial disc help you move more readily and with less pain and will keep your spine flexible.

Artificial discs have become new, but they’re a fascinating development in back surgery. But 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.

Risks of Spinal Surgery

As with absolutely any procedure, there are risks involved with spine surgery for degenerative disc disease. Before requesting one to sign a surgical consent form, your doctor will discuss possible risks along with you. Possible complications include, but are not limited to:

• harm to nerves or your spinal cord
• non-healing of the bony fusion (pseudoarthrosis)
• failure to enhance
• instrumentation breakage/failure
• infection and/or bone graft site pain
• pain and swelling in your leg veins (phlebitis)
• urinary difficulties

Complications could result in more surgery, so again —make certain that you completely understand the risks along with your surgery before proceeding. The decision for surgery is yours and yours alone.

Recovering from Degenerative Disc Disease Surgery

After surgery for DDD, you will not immediately feel better. Should you have had a fusion, it will require some time (several months or longer) for the fusion to heal properly, and in the interim,, you could have pain in the region where you had surgery. Your incisions should heal in 7 to 14 days.

Your surgeon will provide you with special directions about what you’ll be able to and can’t do following surgery. Be sure to stick together with the healing plan and never overdo it or overstress your back. Report any issues—such as increased pain, temperature, or infection—to your physician immediately.

The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 . 

By Dr. Alex Jimenez

Additional Topics: Preventing Spinal Degeneration

As we age, it’s natural for the spine, as well as the other complex structures of the spine, to begin degenerating. Without the proper care, however, the overall health and wellness of the spine can develop complications, such as degenerative disc disease, among others, which could potentially lead to back pain and other painful symptoms. Chiropractic care is a common alternative treatment option utilized to maintain and improve spine health.

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