Guide to Advanced Surgery for The Spine
Why Choose Cedars-Sinai Marina del Rey Hospital for Degenerative Disc Disease Treatment?
The highly skilled, well-trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital can evaluate patients with degenerative disc disease and advise an individualized treatment plan. There are several conservative and surgical treatment approaches for spinal disc problems. Our physicians will work with you to decide on the appropriate treatment plan.
Degenerative disc disease (DDD), commonly referred to as spondylosis, refers to intervertebral disc damage that occurs as a result of natural degenerative changes in the spine. Genetic factors and lifestyle directly affect the deterioration of the spine. DDD is most common in adults above the age of 50. DDD can occur at any segment of the spine, but it's most common in the lumbar spine (lower back region) and the cervical spine (neck region), due to the fact that both areas do the most weight bearing and movement. Over time, intervertebral discs lose water and proteins, becoming weak. Continual pressure on the soft spinal discs can also lead to increased wear and tear. DDD can cause back and neck pain. DDD can lead to the development of other medical conditions, such as osteoarthritis of the disc cartilage, herniated disc, and spinal stenosis. All of these conditions exert pressure on the spinal cord and nerve roots.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Degenerative Disc Disease
There are two major types of surgery used to treat degenerative disc disease. They are:
- Decompression Surgery: Removal of the disc or fragment that is causing pain
- Stabilization Surgery: Spinal fusion
The types of spinal decompression surgery include:
Posterior Approach: This decompression procedure is performed from the back of the spine. Posterior approach surgeries include:
- Facetectomy: This procedure involves the removal of the facet joints that exert pressure on the spinal nerve.
- Foraminotomy: This surgery is performed when a disc fragment or bone spur presses against a nerve at the foramen of the vertebra. The procedure involves enlarging the foramen so that the nerve is no longer compressed.
- Laminectomy: This procedure involves the removal of either a part of or the entire bony plate called the lamina when it presses against the spinal cord.
Anterior Approach: With certain conditions, such as a herniated disc, the decompression procedure will be performed from the front of the spine. Anterior approach surgeries include:
- Discectomy: During this procedure, either a portion or the entire disc that's pressing on the spinal nerves is removed. A discectomy can be minimally invasive. In these cases, smaller incisions are made and the procedure is performed with the aid of a microscope and tiny surgical instruments. patients who undergo a minimally invasive discectomy will have a smaller likelihood of post-operative complications and a faster recovery time.
- Corpectomy (Vertebrectomy): in some cases, the intervertebral disc gets trapped in between the vertebral body and the spinal cord and, as a result, it cannot be removed using a discectomy technique. In this situation, the whole vertebral body is removed through a procedure called corpectomy or vertebrectomy. Sometimes bone spurs develop in between the vertebral body and spinal cord. In these cases, the vertebral body is removed in order to access the disc that is impinging on the nerve.
Stabilization Surgery: This procedure is recommended when the spine becomes unstable and shows abnormal movements due to the removal of a part or all of the spinal disc. In these cases, a surgeon will stabilize the spine through spinal fusion, which involves the use of a bone graft or a substance that stimulates bone growth. Tools, such as wires, screws, rods, and plates may also be used to enhance the patient's spinal stability. A spinal fusion procedure restricts movement in between the vertebrae and will keep the spine stable for a prolonged period of time.
Drugs and other Treatment for Degenerative Disc Disease
Regular Exercise »
Cutaneous Stimulation »
Epidural Steroid Injection »
Physical Therapy »
Lifestyle Modifications »
Degenerative disc disease is subdivided into three types based on the segment of the spine that is affected.
Thoracic Disc Disease »
Lumbar Disc Disease »
Cervical Disc Disease »
Symptoms of Degenerative Disc Disease
Degenerative disc disease is normally asymptomatic and mild conditions often go unnoticed. Symptoms, such as pain, may develop only if a fragment of the deteriorated disc impinges on a nerve root. Symptoms of DDD commonly occur in the back or neck, and may include:
- Severe, disabling pain while sitting, bending, or lifting
- Pain that lessens when lying down or by changing positions
- Tingling sensation or numbness in the extremities
- Muscle weakness in the leg
- Limited range of motion
- Loss of bladder and bowel control
Diagnosis of Degenerative Disc Disease
To diagnose DDD, a doctor will perform a careful physical examination and ask questions about a patient's symptoms and routine habits. Imaging tests, such as X-rays and magnetic resonance imaging (MRI) scans, may be used to confirm a suspected diagnosis, or in cases of trauma. X-rays can show reduced intervertebral space, the presence of bone spurs, and the hypertrophy of facets. MRI scans use magnetic and radio waves to produce images that reveal layers of the spine, as well as nerves, ligaments, and other soft tissue. MRIs can show spinal stenosis (narrowing of spinal canal), herniated discs, and loss of water content in the spinal discs.
Risk Factors for Degenerative Disc Disease
There are several risk factors that contribute to the development of DDD. Aging is one of the major factors that cause your spinal discs to degenerate. Others include:
- Loss of water content in the disc: With advancing age, the water content in the intervertebral discs decreases, making them ineffectual shock absorbers.
- Routine activities and sports: People whose jobs involve lifting heavy objects and those who participate in contact sports are at a greater risk of developing DDD. With repeated stress, the outer wall of the disc may tear away, leading to a loss of elasticity.
- Traumatic injuries: Spinal injuries that cause swelling and instability may contribute to the development of DDD. As spinal discs have a minimal blood supply, if a disc is injured, it begins to degenerate rather than repair itself.
Causes of Degenerative Disc Disease
Degenerative disc disease is a condition that often occurs because of age-related changes in the spinal discs, such as water loss and small cracks or tears in the outer shell of the disc. Excessive body weight may also trigger the development of DDD. A sudden trauma to the spine, such as one resulting from a fall, may also initiate the degenerative process. Bony overgrowths or osteophytes may form around the disc as a response to the decreased intervertebral space. These bony growths may exert pressure on the spinal nerves, causing pain and nerve malfunction.
Alternative medicine treatments can help alleviate pain and other symptoms caused by pinched nerves. Most patients have found alternative treatment approaches beneficial in relieving the symptoms of DDD, despite the fact that these treatments have not been scientifically proven. These therapies include:
- Acupuncture: This ancient method was developed in China and it involves the careful insertion of very fine, hollow needles into precise pressure points throughout the body. The practice works to relieve local, as well as radiating pain associated with DDD. Based on the exact location of the compressed nerve, the practitioner will decide to insert multiple needles, which remain in the body for about 20-40 minutes. This method will trigger the release of neurochemicals, such as endorphin and serotonin, into the blood, which relieves pain and accelerates the healing process.
- Herbal Remedies: There are herbal medications that are considered to relieve symptoms of DDD. However, it is always best to consult with your doctor before taking any such remedy, as there could be adverse effects or interference with another medicine. Some herbal remedies for DDD include:
- Devil’s Claw: This herb originated from the southern parts of Africa and is known for its anti-inflammatory properties.
- S-adenosylmethionine: This substance is beneficial in the treatment of age-related changes in the spine, such as DDD and osteoarthritis.
- White Willow Bark: This herb is helpful in relieving acute back pain by virtue of its anti-inflammatory properties.
- Chiropractic Treatment: The main objective of chiropractic treatment for DDD is to improve the patient's range of motion by getting rid of inflammation. A treatment method called spinal manipulation, or spinal adjustment, is used to treat symptoms of DDD. The common types of spinal manipulation include:
- Specific Spinal Manipulation: In this method, the joints with restricted or abnormal motion will be identified, then a gentle thrusting technique is used to restore joint movement.
- Flexion-distraction Technique: In this method, a gentle but non-thrusting technique is employed. It is used in the treatment of spinal stenosis and herniated discs.
- Instrument-assisted Manipulation: In this method, a hand-held instrument is used to apply gentle force without directly thrusting into the spine.
- Manual therapy techniques that are used to treat symptoms of DDD include:
- Trigger-point Therapy: This therapy involves identification of painful points in a muscle, followed by the application of direct pressure to these points in order to relieve tension.
- Therapeutic Massage: This therapy is done to relieve tension in the muscles and involves a gentle stroking and kneading of the tissues and muscles in the back. This type of therapy will increase the blood flow and help restore a normal level of oxygen to the muscles.
- Other chiropractic treatment methods that reduce inflammation include:
- Interferential Electrical Stimulation: In this method, a low-frequency electrical current is used to stimulate the muscles and decrease inflammation.
- Ultrasound: In this method, sound waves are directed deep into the muscle tissues to relieve pain, stiffness, and muscle spasms. During this treatment, a gentle heat is produced that improves circulation.
- Prolotherapy: The main goal of prolotherapy is to trigger the regrowth of new ligaments and tendons that help maintain spinal stability. This treatment involves an injection of a mild irritant solution, or a proliferant. This solution initiates the healing process and the regeneration of tissue by causing inflammation that triggers the body’s healing mechanism. Several sessions of prolotherapy injection may be required to show desired effects.
- Yoga: The majority of people with DDD have found yoga beneficial. These stretching exercises help promote relaxation, keep the spine flexible, and relieve back pain. It is important to consult your doctor before performing yoga in order to make sure it suits your spinal condition.
There are measures you can take to prevent the development of DDD and to maintain your spinal health. They include:
- Maintain a healthy weight: With advancing age, the water content in the discs decreases, leading to their inability to act as shock absorbers.
- Avoid use of tobacco products and limit alcohol consumption: Smoking and drinking alcohol can cause malabsorption of nutrients and can lead to dehydration. Stopping smoking and drinking can help you maintain your overall health, as well as your spinal health.
- Lifestyle modification: Avoid sedentary lifestyle, as it can lead to sagging muscles and ligaments in the neck and back, which cause the spinal discs to receive more impact and support motion.
- Behavior modification: Taking certain precautions at work, at home, and even during your sleep can help decrease the stress placed on your spine, which in turn reduces degeneration of the discs. You should always maintain a correct posture while at work; keep your backbone straight and use a chair with proper low back support. Make a habit of taking a break every two hours to walk and do stretching exercises. At home, be careful when lifting heavy objects. Always bend from the knees, rather than from the waist when lifting things. Sit with your spine in a straight position and make sure there is a proper support to your neck and lower back region. Sleep on a medium-firm mattress and use a pillow with good cervical support. Sleep on your back, or keep a pillow in between your knees if you want to sleep on your side.
Are you suffering from lower back pain? The specially trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital can answer any questions, and provide information and guidance related to degenerative disc disease treatment.