Degenerative disc disease commonly occurs with age, as discs become more
brittle, less resilient and more prone to herniation. Degenerative
disc disease is the single most common diagnosis related to serious
back and neck pain. When a disc herniates in the spine, the surgeon
can sometimes simply remove a portion of the disc. In other cases,
where the disc is more damaged and must be removed, something must
be placed into the disc space. Otherwise, the two vertebrae will collapse
on top of one another, placing pressure on the nerve roots that branch
off from the spinal cord.
Some of the contributing factors of degenerative disc disease are family history, lifestyle and age. The prime age for disc-related problems is after 35. If a parent had back or neck surgery for a herniated disc, you should be particularly concerned about taking care of your back. Lifestyle is another important factor. Those who perform frequent lifting or put themselves in situations where the spine is exposed to trauma or repetitive shock can also develop degenerative discs over time.
Osteoporosis can lead to disc degeneration. As bones weaken, a person becomes increasingly at risk for vertebral fractures.
Degenerative disc disease makes the back more prone to injury and can contribute to the following conditions:
Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.
A typical solution for problems related to DDD is a spinal fusion procedure.The main problem with fusion surgeries is that they don't often turn out well. While some studies claim a success rate of about 75 percent, that still leaves one in four surgeries as not successful. The second problem with fusion surgery is that there is a reduction in mobility that can cause other problems over time Because the fusion locks a vertebral segment from rotating, it causes more stress on the level above and below the fused site, which in turn can herniate these other discs. Thankfully, there is an alternative today—artificial disc implantation.
Dietary supplements or medications may be recommended to treat degenerative disc disease that is linked to osteoporosis.
Dr. John Regan, a Los Angeles Spine Surgeon, performs artificial disc replacement (ADR) procedures and previously preformed them as part of an Federal Drug Administration clinical trial. When performing ADR for degenerative disc disease, the doctor inserts a small prosthetic (artificial) disc comprising a polyethylene core that slides between two metal end plates. The end plates are attached to the vertebral body with anchoring teeth built along the rim of the end plates.
The prosthetic discs replace the injured discs, helping to relieve chronic back pain. The polyethylene core allows movement of the spine, unlike fusions which prevent normal movement. The disc is made of the same material used in artificial hips and knees.
Pinpointed bone growth and formation is vital to the supporting structures of the spine. Bone morphogenic protein (BMP) is a substance that stimulates bone growth and can be based on and matched to properly identified material from the patient. Material such as BMP can be used to produce a spinal fusion without the additional pain of using the patient's own bone for this purpose. BMP can be implanted to allow support for the structure of the spine in a way that bone grafts have difficulty doing. BMP relies on the patient's own genetic makeup to provide safe, effective bone growth for the patient.
If you imagine the disk as a jelly doughnut, the annulus fibrosis (a ring of cartilage between the vertebrae) is the doughnut and the nucleus pulposus (a gel-like material inside the annulus) is the jelly. If you have a herniated disk, it's as if the jelly is squeezed out of the doughnut. Research is currently underway to create an artificial replacement materials, such as hydrogels and various polymers, for the nucleus pulposus when all or part of it is removed. The objective of implanting replacement material is to maintain or restore the physiologic (normal functional) height of the intervertebral disc space, as well as the mobility and the mechanical function of the spine.
Minimally invasive surgery is available at Dr. Regan's private practice for annular tears. Microdiscectomy is a procedure in which a small incision is made in the back and part of the nucleus that is putting pressure on the nerve is removed. Annular tears can also be treated with intradiscal electrothermal therapy (IDET). IDET applies heat to the fibers in the annulus, which puts a "seal" on the tissue and allows it to heal. Dr. Regan is a pioneer and leading authority in the field of Minimally Invasive Spine Surgery, he has developed a number of new approaches that reduce patient recovery time and improve outcomes.
Current treatments for many spine problems require bone grafts. Unfortunately, up to 40 percent of spinal fusions may fail to form adequate bone. In 1997 a gene was discovered that induces bone growth. Cell culture and early animal studies suggest the gene is key to the body's ability to build new bone. The technology to grow new bone has enormous potential. Although not available yet, local gene therapy for spine fusion is poised to move from bench research to the operating room.
A natural byproduct of aging is the loss of resiliency in spinal discs and a greater tendency for them to herniate, especially when placed under a weighty load, like when we lift heavy objects. Additionally, some people have a family history of degenerative disc disease, which increases their own risk of developing it. When a natural disc herniates or becomes badly degenerated, it loses its shock-absorbing ability, which can narrow the space between vertebrae.
Patients with a diseased disc between L4 and L5 or between L5 and S1 (all in the lower back) that is worn out or become injured and causes back pain are candidates for the artificial disc. Other candidates include those with degenerative disc disease (DDD) whose bones (vertebrae) have moved less than 3mm. Your physician will help you determine whether or not the artificial disc is a good choice for you. Factors that will be considered include your activity level, weight, occupation and allergies.
Generally speaking, those who receive artificial disc replacements return to activity sooner than traditional fusion patients. Also, because there is no need to harvest bone from the patient’s hip, there is no discomfort or recovery associated with a second incision site. Some of the overall benefits of artificial disc surgery include:
While the artificial disc may well be a promising new technology, most spine surgeons today are very cautious. There are many serious concerns including:
Consult with your spine surgeon to determine your best option. Click here to learn more about the artificial disc.
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