Degenerative Disc Disease Treatment Options

Degenerative disc disease (DDD) refers to the changes in the spinal discs that occur in the natural aging process. Spinal discs act as shock absorbers between the vertebrae, helping the back remain flexible and enabling movements such as bending and twisting. Over time, these discs can deteriorate or break down, leading to pain, weakness, instability, and reduced mobility. Pain, weakness, and numbness may radiate down the leg.

What are the treatment options for degenerative disc disease?

Treatment for degenerative disc disease focuses on relieving pain, improving mobility, and helping the individual maintain an active lifestyle. Options include:

Non-surgical Treatments

• Physical Therapy: PT involves tailored exercises to strengthen the muscles around the spine (multifidi), increasing flexibility and reducing pain.
• Occupational Therapy: OT can help patients regain independence in all areas of life.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can be used to manage pain. In some cases, muscle relaxants or oral steroids are prescribed.
• Lifestyle Changes: Weight management, quitting smoking, and regular physical activity can alleviate symptoms and improve overall spine health. Applying heat can improve circulation, reduce muscle spasms, and improve mobility. Ice packs can reduce inflammation and numb mild pain.
• Bracing: A back brace can help support the back and reduce pain.
• Massage: Massage can relieve pain, improve circulation, relax muscles, and improve flexibility and mobility.
• Manual Manipulation: Also called chiropractic care, it is popular for temporarily reducing low back pain.
• Acupuncture: Acupuncture is a traditional Chinese medicine technique used for thousands of years to treat various ailments, including low back pain. It involves the insertion of thin needles into specific points on the body, known as acupuncture points, to alleviate pain and promote healing. Acupuncture can reduce inflammation, relax muscles, relieve the symptoms of degenerative disc disease, and improve quality of life.

Interventional Pain Therapies

• Epidural Steroid Injections (Facet Joint Injections): Steroid injections are made in the joints next to the damaged disc to help reduce inflammation and provide effective pain relief.
• Facet Joint Rhizotomy: This is also called radiofrequency ablation or radiofrequency neurotomy. It is a minimally invasive procedure used to treat chronic pain, particularly in the spine. It deadens the nerves around the joint to prevent pain signals from reaching the brain. It is often recommended for individuals with back or neck pain stemming from the facet joints, which are small stabilizing joints between and behind adjacent vertebrae. Pain from these joints can occur due to arthritis, injury, or mechanical stress. The effects of this procedure can last for months to a few years.

Facet Joint rhizotomy is considered when:

• conservative non-surgical treatments have failed to provide adequate pain relief
• there is substantial evidence that the facet joints are the source of pain and
• chronic pain significantly impacts the patient’s quality of life.
• Intradiscal electrothermal annuloplasty: This minimally invasive procedure has been proven to be effective in treating lumbar degenerative disc disease. It targets the fibrous outer ring of the vertebral disc, which provides structure and contains its contents. Controlled thermal energy is applied to the outer ring, which can tighten and stabilize the disc structure, reduce disc bulging, and destroy small nerve fibers to eliminate pain.

It is considered when a patient has:

• Chronic low back pain due to disc degeneration without significant disc herniations
• The patient has not responded to conservative treatments, and
• There is evidence of disc degeneration in imaging studies without signs of severe spinal canal narrowing or nerve root compression.

Surgical Treatments

Surgery might be considered if conservative treatments fail and the pain is persistent and debilitating, significantly affecting quality of life. Surgical options include:

• Discectomy: A discectomy removes a portion of a disc pressing on a nerve root or the spinal cord.
• Laminectomy: A laminectomy is decompression surgery aimed at relieving pain and functional impairments by relieving pressure on the spinal nerves caused by spinal stenosis. Lumbar spinal stenosis involves a narrowing of the spinal canal in the lower back, which can compress the nerves traveling through the area. This compression can lead to symptoms such as pain, numbness, or weakness in the legs, back, and buttocks.
• Anterior cervical discectomy and fusion: This surgery is commonly performed to treat cervical degenerative disc disease (CDDD). During surgery, the damaged disc is removed (discectomy) to relieve pressure on nerve roots and/or the spinal cord, and the space between the vertebrae is fused using a graft (from the patient’s own bone or a synthetic material).
• Spinal Fusion: Spinal fusion is the standard surgical treatment for lumbar disc degeneration. It involves fusing or joining two or more vertebrae with implants, plates, rods, and bone grafts to stabilize the spine. The goal is to eliminate pain by eliminating motions at the spinal joints.
• Artificial disc replacement: The damaged disc(s) is replaced with an artificial disc. It can be used for cervical and lumbar degenerative disc disease. Artificial disc replacement offers an alternative to fusion surgery for patients younger than age 65 who are suffering from significant chronic neck or lower back pain due to degenerative disc disease. It preserves spinal motion but is only available for patients who have one or two levels of degeneration and who do not have significant facet joint disease, spinal stenosis, or spinal instability. For carefully selected patients, it can significantly reduce pain and disability.

The treatment choice is made between the patient and your Ortho Illinois board-certified orthopedic surgeon, considering the severity of symptoms, the patient’s overall health, and their lifestyle and preferences. We specialize in finding solutions for our patients with chronic pain to improve their quality of life and function. Ortho Illinois is the leading bone and joint provider in Northern Illinois. We have offices in five convenient clinic locations. Call us to find a location near you and begin your journey to top-quality, one-stop, multi-specialty orthopedic care.

References

• https://www.medicalnewstoday.com/articles/266630
• Md MY, Md CG, Md CW, MSc YC, MSc HJ, Md IH, Md CC. An Analysis of the Clinical and Radiological Prognostic Factors Affecting the Outcomes of Lumbar Intradiscal Biacuplasty. Int J Med Sci. 2023 Jul 9;20(8):1115-1122. doi: 10.7150/ijms.85777. PMID: 37484806; PMCID: PMC10357441.
• Shan Y, Zhang J, Ma Y, Zhang Y. The effects of acupuncture combined with Western medicine in treating neck, shoulder, lumbar, and leg pain. Am J Transl Res. 2023 Jun 15;15(6):4246-4254. PMID: 37434859; PMCID: PMC10331671.