DEGENERATIVE DISC DISEASE | INTERVERTEBRAL DISC REPLACEMENT / INTERBODY CAGE
Symptoms and causes | Diagnosis | Disc replacement surgery | Benefits of the surgery | Frequently Asked Questions | Consultations & second opinions
Degenerative disc disease (DDD) is a condition in which the discs in the back or neck begin to wear away and deteriorate. DDD can occur in both the lumbar or cervical spine.
The most common symptoms include pain in the back or neck, numbness or tingling in the arms or legs, stiffness and limited mobility.
Degenerative disc disease in the cervical or lumbar spine involves gradual wear and deterioration of the disc structure. Over time, the intervertebral disc loses its function as a buffer between the vertebrae and can no longer withstand enough pressure.
This can constrict and irritate the nerve roots where they leave the spine, causing pain, numbness or weakness in the affected area.
Cervicalgia (neck pain) is pain in the cervical spine, which is often caused by tension or excessive strain on the neck muscles.
Cervicobrachialgia is a form of pain that begins in the cervical spine and radiates into the arm. There are various causes such as poor posture, muscle tension, degenerative changes in the spine, a herniated disc or, similarly to cervicalgia, due to injury.
Lumbalgia (lower back pain) is pain in the lumbar spine – mostly due to the same causes as cervicalgia.
Lumboischialgia (sciatica) is a type of pain that begins in the lumbar spine and radiates down the leg.
DDD can be caused by age-related changes, injuries, excessive strain on the spine, infections or genetic factors.
The first and fundamental step in treating DDD is making an accurate diagnosis to ensure that effective treatment can be provided.
The diagnosis of degenerative disc disease of the cervical and lumbar spine is usually based on a comprehensive medical history, a physical examination and imaging such as magnetic resonance imaging (MRI) or computed tomography (CT scan).
The consultation will also include detailed questions about the symptoms, medical history and any previous illnesses.
The reflexes, muscle strength and sensitivity of the affected area are assessed during the physical examination.
Imaging provides a detailed view of the spine and the affected discs and can enable accurate diagnosis of the condition.
Neurosurgical treatment of degenerative disc disease is advisable in the following circumstances:
- The pain is caused by a degenerative disease of the intervertebral disc.
- The degeneration is not resolved by conservative therapies or physiotherapy. The pain remains unacceptable and reduces the quality of life.
- The degeneration compromises the person’s motor and sensory neurological function and the associated risk is lower with surgery than with conservative management.
Surgery should be considered if the symptoms are not resolved by conservative treatment. In this case, the damaged or degenerated disc tissue is removed and replaced with a disc prosthesis or intervertebral cage. The prosthesis or cage takes over the function of the original intervertebral disc tissue and can stabilise the spine and relieve stress on the nerve roots.
Spinal disc replacement surgery can be performed using different approaches to access the spine: dorsal, dorso-lateral, or anterior.
The approach chosen by the surgeon depends on the nature and location of the problem (anterior, posterior or posterolateral to the nerve structures) and the risk of the surgical approach in relation to the somatic and anatomical characteristics of the individual.
Another important factor in choosing the surgical approach to the spine and disc is the risk of complications and the likelihood of success of the chosen approach in the specific case.
In all cases where surgery can successfully treat the individual’s degenerative disc disease, an anterior approach to surgery is preferred.
ALIF VS. XLIF SURGERY (ANTERIOR LUMBAR INTERBODY FUSION VS. EXTREME LATERAL INTERBODY FUSION)
Two preferred surgical techniques are known as anterior lumbar interbody fusion (ALIF for short) and extreme lateral interbody fusion (XLIF for short). These are used to treat issues such as spondylolisthesis, degenerative nerve disease or nerve compression with back pain.
In this surgical procedure, the intervertebral disc between two vertebrae is removed and replaced with a special cage. The procedure is performed from the front or the side to achieve optimal stability and relieve stress on the nerve structures.
The ALIF and XLIF methods have advantages over traditional methods that are performed using a surgical approach from the back of the spine. The ALIF procedure increases the disc space and improves the spinal curvature without affecting the posterior muscles. In addition, ALIF and XLIF are minimally invasive, which means shorter hospital stays, less pain and faster recovery.
Studies have shown that the ALIF procedure provides better restoration of disc height and spinal curvature compared to other methods and that patients undergoing ALIF surgery experience significant improvements in pain relief and physical health.
Anterior spinal surgery is an effective method of treating herniated discs in the cervical and lumbar spine.
Advantages of surgery from the front (anterior):
- Direct access: The anterior approach enables the surgeon to reach the affected area directly, allowing for better visibility and precision.
- Reduced blood loss: Because no major blood vessels need to be cut through during the procedure, blood loss is typically lower compared to posterior spinal surgery.
- Shorter recovery time: Most people undergoing anterior spine surgery usually have a shorter recovery time than for other types of spine procedures.
- Less postoperative pain: Most people report less postoperative pain after anterior spine surgery than with other types of spine procedures.
- Less scarring: Because anterior spine surgery is performed through small incisions, the scars are usually smaller and less visible than with other types of spine procedures.
Using an anterior approach leaves the muscles that move, support and carry the spine fully intact. This has the great advantage that post-operative muscular pain can be significantly reduced and post-operative muscle function remains intact.
How long is the recovery time?
The recovery time after anterior spinal surgery depends on many factors including the extent of the surgery, the person’s age and their general health.
Generally, it will be several weeks to months before the patient can fully return to normal activities. It is important to follow the surgeon’s postoperative instructions closely including the required physiotherapy or rehabilitation.
How is the procedure performed?
The procedure is performed through a surgical approach from the front of the neck or abdomen. The various tissues are moved apart to gain access to the affected area of the spine.
In some cases, important blood vessels and organs such as the aorta, vena cava or intestine must also be retracted (moved out of the way) to access the affected area. The surgery is usually performed under a general anaesthetic.
How will mobility change after the procedure?
It is important to note that each case must be considered on an individual basis and there is no guarantee of specific mobility improvement following the procedure.
After a spinal fusion procedure using a cage, the mobility in the affected area is limited because the vertebrae are fused together.
However, after an procedure to place a disc prosthesis, mobility is retained because the prosthesis imitates the natural mobility of the spine. However, certain restrictions can also occur with a prosthesis implantation, as the mobility of the new joint is limited.
Cav.Dr. med. (I) Alessandro Rustia has many years of experience and a high level of expertise in spinal surgery and pain therapy. We ensure rapid, expert assessment and treatment in line with the latest medical findings. Don’t hesitate to get in touch if you would like a second opinion.
Because the Pyramid Clinic is a private clinic, patients here require supplementary insurance. You will therefore need private or semi-private insurance for your treatment. If you have general insurance you can also be treated here if you opt to pay for an upgrade.