Surgery for degenerative disc disease mostly consists of decompression whereby the offending disc bulge is removed, either by open or endoscopic surgery. A small amount of bone of the vertebra may have to be removed to facilitate this operation.

The operation can be done by traditional open surgery,

or microscopic surgery or by endoscopic or

percutaneous spine intervention.

All these methods have specific indications

and are not universally applicable

i.e. some cases may not be suited for

endoscopic surgery.

Disc damage can take many forms, the most dramatic of them being  a large tear of the outer cover or the annulus sometimes with a small fracture of the accompanying vertebra. The core of the disc may then be extruded out through this defect. This is called an acute intervertebral disc prolapse or PIVD.

However, in the majority of cases, the disc undergoes a series of small injuries with recurrent sometimes asymptomatic  herniations, which leads to gradual attrition of the disc, loss of consistency, and gradual settling and bulging of the disc much like an old tyre  which is called chronic degenerative disc disease.

The predominant signs and symptoms of disc degeneration and prolapse are firstly related to the tearing and inflammation of the disc structures which cause back pain of varying severity and muscle spasm and back stiffness.

Secondarily, in about 50% of all cases, the bulging or protruding disc presses on the nearby nerves and spinal cord and thus causes irritation or compression of the nerves which causes pain in the hands or legs, radiating down the limb sometimes accompanies by numbness and weakness of the limbs. 

It mus be therefore understood  that degenerative disc disease is primarily a damage to the intervertebral joint and the nerves and spinal cord are only secondarily affected.

The treatment of degenerative disc disease therefore consists mainly of rest and antiinflammatory medication and physical therapy  to reduce and settle the swelling and pain and allow the body to repair itself. 

In a small (5%) number of cases, the offending disc bulge may be so large and resistant to treatment as to require surgery. 

Degenerative Disc Disease

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The spine is actually a system of "Link joints" with about 24 vertebra, which are all individual bones joined together with a complex joint system which gives it the unique combination of stiffness and mobility. The vertebrae can be likened to a number of blocks which form a chain like link jointr and move relative to each other , with defined limits to movements.

The joints between the vertebrae are consisting of the INTERVERTEBRAL DISC  at the front and a combination of FACET JOINTS AND UNCOVERTEBRAL JOINTS at the back. Each or all of these joints are susceptible to injury , infection or degeneration with resulting change in the stability of the spine with resultant instability and pain.

The most common structure implicated in degenerative back pain is the intervertebral disc popularly called the 'gap' between the vertebrae.

This disc consists of the soft core and a tight, hard covering called the annulus, much like a inflated rubber tyre.

MATHUR ORTHOPAEDICS AND  SPINE CENTER