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
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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