Surgery for Degenerative Disc Disease

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:
Surgical room with computer equipment.You have to meet some rather stringent requirements in order for your doctor to recommend surgery.

  • You've tried several months—usually about six months—of non-surgical treatments, and they haven't helped reduce your pain. This means that you've tried medications, physical therapy, rest, etc, and your pain is still interfering with your life.
  • Your disc degeneration is at just one or two levels. If you have multi-level disc degeneration, you may not be the best candidate for surgery because you may lose too much mobility in your spine if you have a fusion (that type of surgery is explained below).
  • You're relatively young. Recovery from surgery can be a tough process, so your body needs to be able to handle it. Younger people are more capable of recovering from surgery than older people who are more susceptible to complications. There isn't a definitive "you shouldn't have surgery if you're older than this" age. Your doctor will be best able to make that recommendation.

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

  • Loss of bowel or bladder control
  • Cauda Equina Syndrome is a very serious disorder. Your cauda equina—or "horse's tail"—is a group of nerves that resembles, aptly enough, a horse's tail. It's located at the end of the spinal cord, and when the cauda equina is compressed, it's a surgical emergency. You may have extreme low back pain, weakness in your legs, radiculopathy (pain that travels from your back and into your legs), and incontinence.

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:

  • Facetectomy: There are joints in your spine called facet joints; they help stabilize your spine. However, 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 leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. "Otomy" means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.
  • Laminectomy: At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina.
  • Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on a nerve structure, so 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). 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:

  • Discectomy: If you have a bulging disc or a herniated disc, it may be pressing on your nerves. In a discectomy, the surgeon will remove all or part of the disc. The surgeon can do a discectomy using a minimally invasive approach. Minimally invasive means that there are smaller incisions and the surgeon works with a microscope and very small surgical tools. You'll have a shorter recovery period if you have a minimally invasive discectomy.
  • Corpectomy (or Vertebrectomy): Occasionally, surgeons will need to take out the entire vertebral body because disc material becomes lodged between the vertebral body and the spinal cord and cannot be removed by a discectomy alone. In other cases, osteophytes form between the vertebral body and spinal cord. In these situations, the entire vertebral body may need to be removed to gain access to the disc material that's pressing on your nerve—that's a corpectomy.

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:

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

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.

Updated on: 02/22/18
Continue Reading
Patient Guide to Bone Growth Stimulation
Continue Reading:

Patient Guide to Bone Growth Stimulation

Learn how bone heals, the risk factors that may contribute to a poor or failed fusion, and questions to ask the spine surgeon.
Read More