Surgery for Degenerative Disc Disease
Degenerative disc disease surgery — an overview of the surgical approaches available
Degenerative disc disease surgery is often the last resort for patients whose pain from degenerative disc disease is so severe that it restricts their ability to work or perform other daily activities. Surgery usually is only recommended if symptoms have not responded to non-surgical treatments like medication, exercise or physical therapy. There are many surgeries available to treat the symptoms of degenerative disc disease, but they can generally be divided into two categories — traditional open spine surgeries and minimally invasive procedures.
Traditional open spine degenerative disc disease surgery
As previously mentioned, there are several approaches to degenerative disc disease surgery. One of the most common types performed is a traditional open spine fusion, which involves permanently joining together one or more vertebrae of the spine through large incisions. A spinal fusion is typically a highly invasive operation requiring the excision of a significant portion of the spinal anatomy. It entails several steps: First, one or more large incisions are created in the neck, back, abdomen or throat. Second, the underlying muscles, tendons, ligaments and investing fascia are severed and distracted while accessing the site of the actual vertebral segment that needs to be fused. Then, the degenerated disc or discs are completely removed, including the periosteum (bone-covering tissue) of the endplates of the vertebrae to be fused. After that, bone fragments from the patient’s own body or another source are packed into the void once occupied by disc. Metallic hardware devices are then affixed to the vertebrae and connected or linked together to secure the vertebrae being fused. The surgeon will then suture the major disrupted muscles, tendons, etc., into approximately their original position (minor structures are ignored). Finally, the skin incisions are closed. Open spine fusion surgery requires several hours to complete and a hospital stay, and involves many significant risks. After an open spine degenerative disc disease surgery, the patient may expect a difficult recovery period that can take many months to complete.
Minimally invasive degenerative disc disease surgery
The other approach to degenerative disc disease surgery includes minimally invasive techniques, such as those offered by Laser Spine Institute. We perform several minimally invasive spinal procedures as alternatives to traditional open spine surgeries for degenerative disc disease. Unlike open spine surgeries, our operations are performed on an outpatient basis and are designed to help patients avoid a lengthy recovery. Plus, our surgeons take care to minimize damage to muscles surrounding the spine, helping to reduce permanent muscle damage.
The specific surgical approach recommended for each patient will depend on the type and severity of deterioration of the disc(s) and the related symptoms. Some cases can be addressed through the following minimally invasive decompression surgeries at Laser Spine Institute:
- Foraminotomy – Small openings called foramina allow nerve roots to exit the spine and branch out into other parts of the body. When these openings are obstructed due to a bulging disc or other spinal deterioration, the nerve roots can become pinched. Our surgeons can address this issue by widening the foramina and giving the nerve roots more space.
- Laminotomy – The lamina is a flat, bony structure sometimes called the “roof” of a vertebra. When a spinal abnormality, like a herniated disc or bone spur, causes narrowing of the spinal canal and consequentially places pressure on the spinal cord, our surgeons can remove a portion of the lamina to make more room. This can alleviate the pressure on the spinal cord and potentially address many of the accompanying symptoms.
- Discectomy – The discs between the vertebrae cushion the spine through every movement, and it’s not unusual for them to become damaged and bulge or rupture over time. Eventually, an out-of-place disc can impinge on nearby nerves and cause a range of symptoms. Our surgeons perform minimally invasive discectomies, a degenerative disc disease surgery that removes the offending material, potentially halting symptoms.
- Facet thermal ablation – Facet joints allow the vertebrae of the spine to glide against one another, but like other joints in the body, they tend to wear down with time. Because the degeneration of such a joint can cause pain, our surgeons perform facet thermal ablations to vaporize painful nerve endings within the joint, in much the same way that dentists perform root canals to deaden nerves in the teeth.
In some cases, the minimally invasive stabilization procedures performed at Laser Spine Institute may better fit a patient’s needs. These surgeries include:
- Decompression with Interlaminar Stabilization™ Device – To address the degeneration of the spine, our surgeons can decompress the affected area to relieve pain and other symptoms, and then insert a coflex© device to stabilize the area.
- Anterior cervical discectomy fusion (ACDF) – This stabilization technique is performed through a small incision on the front of the neck. Our surgeons remove an affected intervertebral disc and then restabilize the surrounding vertebrae in order to alleviate the symptoms associated with degenerative disc disease.
- Posterior cervical fusion – Similar to the ACDF procedure, a posterior cervical fusion is performed when DDD or another spinal condition affects the neck. In this case, the small incision is made on the back of the neck, and fusion of adjacent vertebrae is performed to add stability to the affected area of the spine.
- Transforaminal lumbar interbody fusion (TLIF) – When degenerative disc disease affects the lumbar spine, a TLIF procedure can relieve instability and compression issues. This procedure consists of reestablishing the proper disc height through the insertion of a spacer and the application of a bone graft.
- Lateral lumbar interbody fusion (LLIF) – Similar to a TLIF, an LLIF consists of making a small incision in the side of the back, through which the surgeon removes a damaged disc from the lumbar spine, thereby decompressing the spine. The stability of the spine is then enhanced through the application of a bone graft fusing two adjacent vertebrae.
- Cervical disc replacement – This procedure consists of replacing a damaged disc in the neck with a prosthetic one in order to stabilize the affected area while increasing mobility.
- Sacroiliac (SI) joint fusion – During this procedure, our surgeons make a small incision in the lower back and fuse a wing of the pelvis (known as the ilium) to the sacrum, the lowest portion of the spine.
In some cases, patients with degenerative disc disease may not respond to conservative treatment, and surgery is suggested. It is reasonable to determine the least invasive, yet most effective, surgical treatment possible. Contact Laser Spine Institute today for a review of your MRI scans, and to receive more information about our outpatient surgeries.