Lumbar Degenerative Disc Disease: When is Surgery Necessary?

What is Lumbar Degenerative Disc Disease?

Degenerative disc disease is a condition affecting the spine by weakening the discs between the vertebrae. This occurs when the discs become drier and less resistant to stress. In more severe cases, the disc may begin to flatten, reducing the space between the vertebrae. This can compress nerves and cause instability, i.e., excessive movement between the vertebrae, potentially leading to a forward slippage of the vertebrae.

Discover degenerative disc disease, a common condition affecting even young people and a leading cause of back pain in adults. Nerve root compression can lead to lower back pain and sciatica.

It's important to remember that the severity of back pain isn't necessarily related to the extent of intervertebral disc changes visible on spinal MRI.

A thorough assessment of the patient's pain is crucial for effective treatment. Treatment begins with non-surgical options.

Symptoms of Lumbar Disc Disease

Lumbar disc disease typically causes back pain, including low back pain.

Backaches, often localized in the middle of the back, or on the right or left side, buttocks, or along the spine (lateral back muscles).
Lower back stiffness;
Hip pain;
Limited flexion (bending forward), extension (arching backward), twisting, or lateral bending.

Unlike sciatica (caused by a herniated disc), low back pain from disc disease usually lacks tingling, electric shock sensations, or numbness. Cold legs or painful tightness in the lower limb, characteristic of sciatica, are also absent.

Conservative Therapy for Lumbar Degenerative Disc Disease

Acute phase treatment includes rest, analgesics, and muscle relaxants. Chronic phase treatment focuses on physiotherapy and maintaining regular physical activity. Surgery is considered if conservative treatment fails and pain interferes with daily life.

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Surgical Intervention for Lumbar Degenerative Disc Disease

Surgery involves stabilizing the affected segment with pedicle screws and rods, typically using a minimally invasive percutaneous technique.

Patients typically go home the day after surgery and can resume normal life (excluding strenuous activity) after two months.

Surgical Options for Treating Lumbar Degenerative Disc Disease

Dynamic Lumbar Stabilization

Dynamic lumbar stabilization is a minimally invasive procedure that aims to maintain vertebral disc position to prevent nerve compression, while remaining reversible. This procedure doesn't remove essential bone, allowing for further treatment if needed.

Discoplasty or Prosthetics

Artificial discs are prosthetic solutions that replace the diseased disc while preserving movement and flexibility.

Lumbar Fusion Surgery

Lumbar fusion fuses two or more vertebrae using bone grafts, metal plates, and screws to stabilize the spine and reduce pain.

Diagnosis of Lumbar Disc Disease

Diagnosis begins with X-rays to detect anomalies like decreased space between vertebrae or bone problems.

MRI is then used to visualize bones and soft tissues (ligaments, discs, muscles). CT scans are rarely used.

Normal findings on imaging are common, even in people without symptoms. Perfect disc health isn't necessary for well-being. Physiotherapy, manual therapy, and targeted exercises often alleviate pain. Focus on care, not perfection.

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