Degenerative Disc Disease (DDD) is very common affecting 40-50% of people over the age of 40 and becomes increasingly common as we age. It is a kind of wear and tear disease similar to osteoarthritis. Although it can occur at any spinal level, it is most common in the lumbar spine (low back). DDD can cause the discs to flatten losing their normal height. This disc height is important as it separates the disc above from the one below. When disc height is lost, the nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain.
Patients have reported their symptoms as being as mild occasional backaches to chronic low back pain that is severe enough to limit their activities at work and play. The pain is typically mechanical in nature. This means the pain increases as more stress or load is placed on the low back. Bending, lifting, and twisting are the types of movement that may exacerbate DDD.
There are several non-surgical treatments including anti-inflammatory medication, physical therapy, epidural steroid injections, and exercise programs. Surgery is only considered when the patient’s symptoms are debilitating; interfere with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months.
The traditional surgical option is fusion where the painful disc is completely removed and the disc space is replaced by an artificial spacer and bone graft so as to fuse the vertebra above the disc to the one below. Stabilization is done using titanium screws placed in the pedicle of the vertebrae and rod connecting the screws. The bone graft is harvested from the patient’s pelvic bone and is inserted along with a spacer in between the vertebral bodies. The spacer is either a titanium mesh cage or a PEEK cage/spacer. It is a time-tested technique and safe in the hands of an expert spinal surgeon. Fusion converts the unstable degenerated spinal segment into a stable segment thereby relieving the pain.
There are some disadvantages of fusion surgery as this converts a functional mobile spinal segment into a non-functional immobile segment. This puts enormous strain on the mobile segment above and may in the future lead to DDD at that level. This theoretical disadvantage is seen if fusion has been done in young active individuals. Moreover the patients can experience persistent pain in the bone graft site.
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