ABOUT DEGENERATIVE DISCAL DISEASE

Lumbar degenerative disc disease
Degenerative disc disease occurs when the discs are “shock absorbers” cartilage between the bones of the spine, undergo a process of degeneration that causes them to lose height and hydration. This makes the disc does not work properly and that usually cause pain. It occurs naturally in most people over the years and is part of the aging process.

Lumbar degenerative disc disease

 
Lumbar spondylosis with hypertrophy of the facet joints
Spondylosis, however, hypertrophy is when the bone of the vertebrae and reduces the space for the spinal cord and its roots.

Lumbar spondylosis with hypertrophy of the facet joints (red arrows)

 

Over the years, both processes occur together, but different diseases can cause a process is more advanced than the other. Disc degeneration, in turn, leads to loss of intervertebral disc height, which reduces the step to the nerve roots laterally beyond the foramina. This can cause compression of the root and trigger pain in the lower back pain as well.


WHAT ARE THE CAUSES OF DISC DEGENERATION?

Disc degeneration is part of the aging process, but there are a number of causes that can accelerate the process and have a relatively young person This advanced disc degeneration:

  • Genetic predisposition: Some families have more early disc degeneration.

  • Obesity: Overweight causes accelerated wear of the intervertebral discs.

  • Lack of exercise, causing muscle weakness of the trunk erector and abdominal wall and thus greater weight load on the spine.

  • Work activity with repetitive lifting weights (especially in bad positions), sitting for prolonged periods, and exposure to continuous vibration (typically a jackhammer).

  • Snuff: carbon monoxide snuff damaged intervertebral disc metabolism. The damage is proportional to the number of cigarettes smoked per day.

  • Injuries: previous interventions of the spine and traffic accidents, occupational or accidental falls, causing disc degeneration. Typically the disc above and below a fused area (merged) is degenerated over the years to provide further mechanical requirements.

SYMPTOMS

Disc degeneration does not always cause pain. Discogenic pain is often back or neck pain. If disc degeneration causing nerve root compression can be pain in the limbs.

Conservative treatments include physical therapy, pain medication and anti-inflammatory cortisone epidural injections and immobilization in bed with a lumbostato or brace and ozone therapy. The goal of treatment is not only relieve pain temporarily, but can return to conduct a normal life, including return to work earlier. When symptoms do not improve within 6 to 12 weeks, consider surgical options

A regular column on the left, right, laminectomy
Laminectomy involves removing the back of the vertebra or sheet (there are two, one on each side) to thereby relieve compression of the spinal cord and its roots. Requires relatively large incisions and causes instability of the spine if not done with special care. Improves root compression and therefore lower limb pain, but no back pain. In the best case does not cause back pain, but not in any way relieves the pain of degenerative disc disease.
A regular column on the left, right, laminectomy

 
Lumbar discectomy
Discectomy: is removal of the interior of the intervertebral disc to relieve pressure on nerve roots there. Back pain is usually worse if not initially, then with the passing years. Microdiscectomy is the same procedure, but being carried out under a microscope or endoscope, reduce the size of the incision in the skin and muscles. The result is a faster recovery of the patient, but long-term results are similar to discectomy (also relieves the pain of the lower limb but, ultimately, back pain worse).

Lumbar discectomy

 
Postero-lateral lumbar fusion
Spinal fusion: is the union of one or more vertebral mobility to eliminate the area of the spine that cause pain. It is used in cases of herniated disc or when there is instability of a segment of the spine. This will put some screws in the vertebrae that are connected with metal rods and bone grafts are placed to create a natural process that fuses callus immobilized vertebrae by metal scaffolding (screws and rods). Remember that the aim is to achieve bone fusion and snuff that blocks this process. Therefore, if you smoke, quit completely and radically. The fusion can be performed using a posterior or posterolateral fusion or anterior (through the chest or abdomen). Currently techniques have been developed minimally invasive spinal fusion to reduce surgical trauma and thereby speed recovery and return to work.

Postero-lateral lumbar fusion

 
L4-L5 disc prosthesis more anterior interbody fusion L5-S1
Disc prosthesis: A surgical technique that replaces the center or nucleus pulposus or the entire disc with an artificial material. The recovery is faster and with less pain than fusion techniques but requires action across the abdomen. By not touching the muscles of the spine, the relatively rapid recovery.

L4-L5 disc prosthesis more anterior interbody fusion L5-S1

 
SURGICAL RISKS

The risks for any surgery are infection, bleeding and nerve injury. In the subsequent pathways are the main risk root lesions in the anterior and injuries to great vessels and retrograde ejaculation (men only). Talk to us to ensure that you understand the specific risks and benefits if the treatment has been recommended.


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