The degenerative disc disease and how to treat such a problem

Let us first define what so called degenerative disc disease or the triple D (DDD); it is the degeneration of the intervertebral disc of the spinal column. The intervertebral disc is a round cartilage that work as a shock absorber between the vertebrae. In the normal cases with growing old this disks degenerate without any problem but with certain cases it ends with inducing pain and limiting the daily activity of the patient.

The main cause of the degenerative disc disease is the trauma, which could be caused by lifting of heavy load with a wrong posture or direct accident in the spinal region. The intervertebral disc is very delicate piece of cartilage with a minimal blood supply. This feature limits the possibilities of it regaining its shape after trauma or healing back into shape, but on the contrary it can dry out and degenerates.

As the fact that some individuals have deeper innervations in their intervertebral discs than others, that leads in case of trauma that the scar tissue formed during healing is innervated. This nerve ending is stimulated continuously by the material of the scar tissue causing pain to the patient.

The symptoms of this disease can be summarized in a chronic low back pain that extends to the hips, thighs and the buttocks of the patient. Sciatica may be indicative for degenerative disc disease because after the rupture of the disk, the spinal channel get thinner pressing on the sciatic nerve root. The pain always increases during actions like sitting, standing, bending and twisting. Usually there is some weakness in the knee and changes occur in posture and gait.

The suggested treatment is related to the severity of the pain from a degenerative disc. If non surgical treatment is ineffective and should be replaced by surgical treatment. The non surgical treatments are effective in cases of mild to moderate pain. It includes medication intake like (NSAIDs) non steroidal anti-inflammatory drugs which are helpful in relieving pain and inflammation.

The epidural (around the spine) injection is another medication that proved its effectiveness in this field. Physical exercises carried out and instructed by physio therapist will reduce the pain as well as chiropractic manipulative therapy (CMT). When we run out of options for non surgical operations we have to go for the surgical one.

It also has a lot of choices according to the case. If we are dealing with a disc in the cervical (neck) region, we carry out the Anterior Cervical Discectomy and Fusion where we reach the cervical vertebra antiriorly and remove the intervertebral disc and replace it by a bone graffiti which will fuse the vertebra. If the degenerated disc fragments are bulging the spinal canal we go for the Facetectomy where the facet of the spinal canal is removed causing widening of the canal and freeing the nerve roots in this region.

If the problem is not with the canal itself but with the foramen where the nerve root emerges from the spinal canal we do the foramenotomy and enlarge the foramen to relieve pressure on the nerve. Laminotomy is a procedure that could be done alone or with the foramenotomy to release the nerve root by removing a part of the vertebra called the lamina.

All this procedures are several ways to relieve pressure on the nerve to decrease the pain for a degenerative disc disease.

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