Surgical Treatments for Degenerative Disc Disease
Degenerative disc disease (DDD) affects millions of individuals. [1] Older individuals are most commonly affected, however DDD can impact younger individuals as well. Within the spine, there are 23 discs that sit between bony vertebrae.
These discs are primarily composed of water, and act like shock absorbers within the spine. As we age, these discs dry out, losing their flexibility and their ability to absorb shock. [2,3] This is ultimately what causes the neck and back pain associated with degenerative disc disease.
DDD generally presents as pain localized to the site of the affected disc, sometimes accompanied by pain and/or numbness that radiates to the limbs. Individuals may also experience back pain and stiffness that is exacerbated by bending forward or lifting heavy objects, and weakness in the legs due to nerve damage. [1,4]
Before considering surgery, your doctor may first try to treat your back pain conservatively. This includes physical therapy, oral analgesics including NSAIDs, opioids, and muscle relaxants, epidural steroid injections, and chiropractic adjustment. [1,4]
However, if conservative treatment is unsuccessful, there are several surgical treatment options available. In many instances, surgical treatment has shown to be more effective at improving pain, physical function, and quality of life as compared to conservative treatments. [5] These surgical procedures are outlined below:
Spinal Decompression Surgery : When discs degenerate, they may bulge and invade the spinal canal, compressing a nerve root or the spinal cord, ultimately causing your back pain. Spinal decompression surgery aims to reduce this pressure by removing bone and soft tissue around the affected disc. This can include facetectomy, foraminotomy, laminectomy, laminotomy, discectomy, or corpectomy. [2,3,4]
Artificial Disc Replacement: This minimally invasive technique removes the damaged intervertebral disc and replaces it with a prosthetic implant. This treatment option preserves joint movement while still reducing pain. [3,4]
Spinal Fusion: This surgery involves the fusion of 2 or more vertebrae together to stabilize and immobilize the affected joint, thereby eliminating pain. Spinal fusion is indicated when there is instability of the spine. It is generally the “last-resort” surgery. [3,4,6]
Risks of Surgery
Like any surgery, the treatments listed above are not without risk. Common complications include blood loss, blood clotting, nerve injury or dural tear, infection, hardware malfunction, or persistent pain. [7-10] Certain risk factors, such as advanced age, previous surgical experience, osteoporosis, and history of smoking, can increase risk of surgical complication. [11] These risks, however, are relatively small. Studies have shown complication rates/reoperation rates between 3.9% and 12.5%. [10,12,13] Higher complication rates are often associated with more complex surgeries. Mortality rates are low, with a rate of 0.321% for complex fusions, 0.105% for simple fusions, and 0.081% for decompression surgery. [14]
Recovery
Standard recovery after surgery for degenerative disc disease often requires about 4-6 weeks before returning to a moderate level of mobility and function, though this may vary depending on the complexity of your surgery and your baseline health and mobility. [15] Most individuals return to work within 4-8 weeks. Several studies report satisfaction rates—both short-term and long-term—after surgery between 71% and 94%. [7,10,12,13,16] Minimally invasive surgery often corresponds to higher satisfaction rates, likely due to shorter operating times, less blood loss, shorter hospital stays, and a quicker return to work. [10,13]
Sources
1.Center TAS. Degenerative Disc Disease: Symptoms & Treatment Options. https://theadvancedspinecenter.com/conditions/degenerative-disc-disease/
2.Scioscia T. Spinal Discs Spine Health https://www.spine-health.com/conditions/spineanatomy/spinal-discs
3.Surgical Options for Degenerative Disc Disease (DDD). Boston Scientific Corporation https://www.painscale.com/article/surgical-options-for-degenerative-disc-diseaseddd#:~:text=Three%20main%20types%20of%20surgery,replacement%20(intervertebral%20disc%20arthroplasty)
4.Wu PH, Kim HS, Jang I-T. Intervertebral Disc Diseases PART 2: A Review of the Current Diagnostic and Treatment Strategies for Intervertebral Disc Disease. Int J Mol Sci. 2020;21(6):2135. doi:10.3390/ijms21062135
5.Chen BL, Guo JB, Zhang HW, et al. Surgical versus non-operative treatment for lumbar disc herniation: a systematic review and meta-analysis. Clin Rehabil. Feb 2018;32(2):146-160. doi:10.1177/0269215517719952
6.Surgery HSHfS. Minimally Invasive Lower Back Surgery for Disc Degeneration: The AnteroLateral (Side) Approach: a new minimally invasive surgical approach to lumbar spine fusion. HSS https://www.hss.edu/CONDITIONS_MINIMALLY-INVASIVE-LOWER-BACKSURGERY-ANTEROLATERAL.ASP
7.Montgomery S. TLIF Back Surgery Success Rates and Risks Spine Health https://www.spinehealth.com/treatment/spinal-fusion/tlif-back-surgery-success-rates-and-risks
8.Risks: Lumbar decompression surgery United Kingdom National Health Service https://www.nhs.uk/conditions/lumbar-decompression-surgery/risks/
9.Rodriguez M. Laminectomy and Spinal Stenosis: Risks and Complications Spine Health https://www.spine-health.com/treatment/back-surgery/laminectomy-and-spinal-stenosis-risksand-complications
10.Spine Surgery: When it works and when it doesnt Ortho Bethesda https://www.orthobethesda.com/blog/spine-surgery-when-it-works-and-when-it-doesnt/
11.Albert T. Spine Surgery Risks and Potential Complications Spineuniverse https://www.spineuniverse.com/treatments/surgery/spine-surgery-risks-potential-complications
12.Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis F. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976). Apr 1 2013;38(7):E409-22. doi:10.1097/BRS.0b013e3182877f11
13.Perez-Cruet MJ, Hussain NS, White GZ, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine. 2014;39(3):E191-E198. doi:10.1097/BRS.0000000000000078
14.Poorman GW, Moon JY, Wang C, et al. Rates of Mortality in Lumbar Spine Surgery and Factors Associated With Its Occurrence Over a 10-Year Period: A Study of 803,949 Patients in the Nationwide Inpatient Sample. Int J Spine Surg. 2018;12(5):617-623. doi:10.14444/5076
15.Recovery: Lumbar decompression surgery United Kingom National Health Service https://www.nhs.uk/conditions/lumbar-decompressionsurgery/recovery/#:~:text=You'll%20be%20encouraged%20to,and%20symptoms%20before%20 the%20operation
16.Dohrmann GJ, Mansour N. Long-Term Results of Various Operations for Lumbar Disc Herniation: Analysis of over 39,000 Patients. Medical Principles and Practice. 2015;24(3):285-290. doi:10.1159/000375499
