Degenerative Disc Disease: Treatment Options and Insights

Degenerative arthritis of the spine

Hello Doctor, I would like to seek your advice regarding my situation: I fell on my buttocks while sitting down in the first year of junior high school.
By the second year, I started experiencing back pain.
Since I was still young at the time, I visited many hospitals without any results.
It wasn't until I was 16 that a CT scan revealed a herniated disc.
The doctor believed that I was too young for surgery, so I did not return for follow-up.
However, I have been experiencing pain every year, and in recent years, the pain has become very severe.
When I went to an orthopedic hospital for an MRI, the doctor informed me that the L4-L5 disc had degenerated and had little space left.
The cause of my pain was likely degenerative arthritis.
The orthopedic doctor recommended that I be referred to a rehabilitation medicine specialist.
After the referral, the rehabilitation doctor clearly told me that even if I received injection treatments, the pain would return once the medication wore off, and the cost of each injection was not cheap.
He suggested that I start with regular rehabilitation therapy.
Since I was still in significant pain, I was referred to a neurosurgeon.
The surgeon then suggested a minimally invasive procedure to ablate some small nerves near the spine.
After the surgery, I still experienced severe pain.
The doctor mentioned that if the pain persisted, I might need another small surgery to aspirate the degenerated disc.
I asked the doctor what would happen if the pain continued after the aspiration.
He said that I might need to have screws placed, but that would indicate that the situation was no longer salvageable, especially since I had already undergone one unsuccessful surgery.
Aspiration of the degenerated disc is likely irreversible, so I would like to ask if aspirating the degenerated disc is currently my only option, or are there other treatment methods available? I sincerely request your advice.

Nai, 20~29 year old female. Ask Date: 2022/01/01

Dr. Wang Shouji reply Orthopedics

Hello, if there is an injury to a single vertebral segment and associated neuropathic pain, it is important to address the issue of nerve compression causing the pain.
If the intervertebral disc is completely damaged, consideration should be given to spinal fusion with instrumentation or artificial disc replacement surgery.
If mobility can be preserved, options such as artificial discs or rehabilitation to strengthen muscle strength may also be better choices.
If there are any concerns, you may seek evaluation from another hospital.
Changhua Hospital cares about your health.
Wang Shou-ji.

Reply Date: 2022/01/01

More Info

Degenerative Disc Disease (DDD) is a common condition that affects the intervertebral discs in the spine, leading to pain and discomfort. It often results from the natural aging process, injury, or trauma, such as the fall you experienced in middle school. Your history of persistent pain and the findings from your MRI indicating a degenerated L4-L5 disc suggest that you are dealing with a significant case of DDD.

Understanding Degenerative Disc Disease
DDD occurs when the discs lose hydration and elasticity, leading to a decrease in disc height and potential herniation. The black appearance of your disc on imaging is indicative of degeneration, which can cause pain due to nerve root compression or inflammation. The pain you are experiencing could also be exacerbated by degenerative changes in the facet joints, leading to osteoarthritis.

Treatment Options
1. Conservative Management:
- Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles surrounding your spine, improve flexibility, and reduce pain. Techniques such as manual therapy, stretching, and strengthening exercises are often beneficial.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. However, as you noted, the effects may be temporary.

- Epidural Steroid Injections: While you mentioned that injections may only provide temporary relief, they can still be a useful part of a comprehensive pain management strategy.

2. Surgical Options:
- Microdiscectomy: This minimally invasive procedure involves removing the portion of the disc that is pressing on the nerve. It is typically recommended for patients with significant nerve compression causing severe pain or neurological deficits.

- Disc Decompression: The procedure you mentioned, where the degenerated disc is "suctioned" or decompressed, can relieve pressure on the nerves. However, it is essential to discuss the potential risks and benefits with your surgeon, especially considering your previous surgery.

- Spinal Fusion: If the disc is severely degenerated and causing chronic pain, spinal fusion may be considered. This procedure involves fusing the affected vertebrae to stabilize the spine, which can alleviate pain but limits motion at that segment.

3. Alternative Therapies:
- Chiropractic Care: Some patients find relief through chiropractic adjustments, although this should be approached cautiously, especially given your history of disc issues.

- Acupuncture: This traditional Chinese medicine technique may help alleviate pain for some individuals.

- Lifestyle Modifications: Maintaining a healthy weight, engaging in low-impact exercises, and avoiding activities that exacerbate your pain can be beneficial.

Conclusion
It is crucial to have a thorough discussion with your healthcare provider about the best course of action tailored to your specific situation. Given your history of persistent pain and previous surgeries, a multidisciplinary approach may be most effective. This could involve collaboration between orthopedic surgeons, rehabilitation specialists, and pain management experts.

If the current conservative treatments are not providing sufficient relief, and if your quality of life is significantly affected, it may be worth considering the surgical options discussed. However, ensure you have realistic expectations about the outcomes and potential risks associated with each procedure.

Ultimately, the goal is to manage your pain effectively while maintaining as much function and quality of life as possible. Regular follow-ups with your healthcare team will be essential in monitoring your condition and adjusting your treatment plan as needed.

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