Degenerative Disc Disease (DDD)


 
Disc are located between the bones of the spine. They act as shock absorbers and add height to the spine. The disc consists of two parts. The inner nucleus pulposus is an area of stringy fibrous material of high water content. it is solid, but weak in structure. The outer fibrous annulus is a strong ligamentous structure that helps contain the disc.
Degenerative disc disease to some extent is hereditary. Often one will have family members with similar back pain problems. Discs gradually decay with aging and the fibrous annular tissue can fracture and lead to herniations of the inner nuclear material. These herniations can cause pain locally in the neck or back, or they can cause pain down the extremity due to nerve compression. 

Many people have chronic back pain due to DDD. This pain is due to the fact that the annular region of the disc is highly innervated. The nuclear material contains chemicals which irritate these nerves that innervate the disc's annular region. The pain associated with DDD is commonly referred to as deep achy pain, with occasional sharp  jolts.

 
There have been many possible solutions for the treatment of DDD. Some have better results than others. Probably the best treatment is an endoscopic discectomy. This will resolve the pain in about 60% of patients with good long term results. Fusions are another option, and they reduce the pain of the discs by stopping the motion of the surrounding bones and thus no motion, no pain. The problem with fusions is that usually the discs above and below the fusion eventually decay and new pain develops in about 5 years from these new degenerated discs. Artificial discs have been developed to try to solve this problem associated with fusions. The concept of the artificial disc is simple, maintain motion of the bones to avoid further disc decay, and at the same time remove the bad disc to stop the pain.  The only concern with these artificial disc is that the steel "discs" will eventually loosen and decay like other artificial joints that have been used. Most artificial joints last about 10 years, and usually replacing these joints are difficult and complicated. The surgery required to implant an artificial disc is quite large and involves opening up the abdomen and moving the abdominal contents and Aorta to achieve access to the anterior spine. Thus, one wonders what the long term success of artificial discs will be. 
    

A normal spine has a disc that maintains a normal space between the vertebra and has no herniations.

Other modes of treatment for DDD involve IDET (intradiscal electrothermocoagulation). IDET has had very poor success rates and usually only amounts to a 20% reduction in pain. Nucleotomy is similar to discectomy except that less material is removed from the disc. Usually a laser is inserted to heat the internal contents of the disc to shrink the disc which is also done in discectomies. The results of nucleotomies are reasonable depending on the study reviewed, but it is overall considered a less effective treatment than discectomy.
 
  Some individuals claim to be able to deinnervate the disc via a annuloraphy procedure. Unfortunately, this is nearly impossible due to the vast innervation of the disc. The nerves that supply sensation to the disc come from multiple nerves and regions. The only way to deinnervate the disc is to actually remove the disc itself. Procedures such as IDET and annuloraphy do not deinnervate the disc to any significant degree and this is why the results with such procedures are extremely poor.

 

 
 
 
 

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