Degenerative disc disease is a problem usually linked with aging. Disc degeneration follows a predictable pattern. First, the nucleus in the center of the disc begins to lose its ability to absorb water. The disc becomes dehydrated. Then the nucleus becomes thick and fibrous, so that it looks much the same as the annulus (fibrous outer covering of the disc).
As a result, the nucleus isn’t able to absorb shock as well. Routine stress and strain begin to take a toll on the structures of the spine. Tears form around the annulus. The disc weakens. It starts to collapse, and the bones of the spine compress.
Treatment for degenerative disc disease begins with a conservative (nonoperative approach). Medications such as antiinflammatories and antidepressants have been found helpful with certain patient population groups. Physical therapy is often the first-line of hands-on treatment. Core training of the trunk (abdomen and back) muscles is used to stabilize the spine. Patients are taught correct posture, lifting techniques, the importance of movement, and other specific exercises that are appropriate for each individual.
When there is acute (recent) low back pain, spinal manipulation by a physical therapist or chiropractor has been shown to be effective. Chronic low back pain requires a different approach altogether with a multidisciplinary team of experts addressing physical, social, emotional, and psychologic issues.
When conservative care fails to reduce pain or restore movement or function, then more invasive treatment such as surgery may be considered. Spinal fusion is the most common procedure done for this problem. But the operation is invasive, provides inconsistent results, and low overall long-term satisfaction. Some studies showed that doing nothing had as much effect as having a fusion.
Like all treatments for low back pain patients, it works for some, but not all, patients. Finding those patients for whom fusion would work best may help narrow down the field and produce better results.
As a result of these mixed reviews for fusion, surgeons have turned their focus in other directions looking for a better solution. The latest development has been what’s called motion-sparing technology. This refers to surgical procedures designed to preserve motion at the diseased level so that the adjacent segments don’t start to degenerate, too.
There are several types of motion-sparing procedures including supportive rods placed alongside the spine, polymers (manmade plastics and proteins) injected into the disc, and total disc arthroplasty (disc replacements).
Disc replacements are fairly new in the United States. Only a small number of patients qualify for this operation. They must have a stable spine and disc degeneration (not a herniated disc). There must be no stenosis (narrowing of the spinal canal), osteoporosis (low bone density or brittle bones), or obesity. Women who are pregnant and anyone with scoliosis, previous lumbar fusion, spinal infection, or vertebral fracture are also not good candidates for disc replacement at this time.