Degenerative Disc Disease: Surgery vs. Rehabilitation Options

Intervertebral disc degeneration

Hello Dr.
Chiu,
My mother is 61 years old.
About nine months ago, she sought treatment for hip pain, and the doctor diagnosed her with cartilage degeneration.
Recently, she has started experiencing numbness in her legs for the past month, so surgery is being considered.
When I researched more information, I found some patient experiences suggesting that rehabilitation could improve her condition, and that it would be best to avoid surgery if possible.

I would like to ask:
1.
None of the doctors my mother has seen have recommended rehabilitation; they only prescribed medication.
Why weren't we informed about rehabilitation? Is it not necessary? Is it ineffective for older patients? Or is there another reason?
2.
My mother experiences gastrointestinal discomfort from the medications prescribed by the doctors (this has been the case with at least three different doctors, and she has informed them and switched medications).
Recently, she has decided to stop taking the medication on her own because she wants to proceed with surgery.
How should we handle this situation?
3.
Given my mother's age of 61, is surgery advisable, or should we try rehabilitation first, considering her condition is not very severe?
Thank you for taking the time to respond.

Heidi

Heidi, 20~29 year old female. Ask Date: 2006/03/12

Dr. Qiu Yushu reply Neurosurgery

There are many causes of lower back pain.
Please visit the outpatient clinic to determine the best treatment method.
Thank you.

Reply Date: 2006/03/12

More Info

Hello Heidi,
Thank you for reaching out with your concerns about your mother's condition. Degenerative Disc Disease (DDD) can be a challenging issue, especially when it comes to deciding between surgical intervention and rehabilitation options. Let's address your questions one by one.

1. Why wasn't rehabilitation suggested?
It's not uncommon for patients with DDD to be prescribed medication without being referred for rehabilitation. This could be due to several reasons, including the severity of the symptoms, the physician's assessment of the patient's condition, or simply a lack of awareness about the benefits of physical therapy. Rehabilitation can indeed be beneficial for many patients, as it focuses on strengthening the muscles around the spine, improving flexibility, and enhancing overall function. However, in some cases, especially when there is significant nerve involvement or severe pain, doctors may prioritize medication or surgical options. Age can also play a role; while older adults may have a slower recovery, many still benefit from physical therapy. It’s essential to have a thorough discussion with the healthcare provider about the potential advantages of rehabilitation in your mother's case.

2. Handling gastrointestinal discomfort from medication:
If your mother is experiencing gastrointestinal discomfort from the medications prescribed, it’s crucial to address this with her healthcare provider. Stopping medication without consulting a doctor can lead to a worsening of her symptoms. There are various alternatives available, including different classes of medications or adjunct therapies that may be easier on the stomach. Additionally, some medications can be taken with food to minimize gastrointestinal side effects. It's important to communicate these concerns to her physician, who can help find a suitable solution.

3. Surgery vs. rehabilitation for a 61-year-old:
The decision to proceed with surgery or to try rehabilitation first should be based on a comprehensive evaluation of your mother's specific condition, including the severity of her symptoms, her overall health, and her personal preferences. Surgery can be effective for certain cases of DDD, particularly when there is significant nerve compression or when conservative treatments have failed. However, surgery carries risks, especially in older adults, including complications related to anesthesia and longer recovery times. On the other hand, rehabilitation can be a less invasive option that may provide relief and improve function without the risks associated with surgery. Given that her condition is not yet severe, it may be worthwhile to explore rehabilitation options first, especially since many patients report improvements through physical therapy.

In conclusion, I recommend that you and your mother have an open discussion with her healthcare provider about the potential benefits of rehabilitation, the side effects of her current medications, and the risks and benefits of surgery. A multidisciplinary approach, possibly involving a physical therapist, could provide a clearer picture of the best path forward. It’s essential to ensure that your mother feels comfortable and informed about her treatment options.

Best wishes for your mother's health and recovery.

Sincerely,
Doctor Q&A Teams

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