Spondylosis

The gradual deterioration of the disc between the vertebrae is referred to as Degenerative Disc Disease (DDD) or Spondylosis. Degenerative Disc Disease is very common affecting 40-50% of people over the age of 40 and becomes increasingly common as we age. It is a kind of wear and tear disease similar to osteoarthritis. Although it can occur at any spinal level, it is most common in the lumbar spine (low back). DDD can cause the discs to flatten losing their normal height. This disc height is important as it separates the disc above from the one below. When disc height is lost, the nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain.

As the ‘discs’ degenerate, they become thinner. Sometimes the vertebrae develop small, rough areas which may irritate the nearby nerves. This causes troublesome symptoms like severe neck pain and stiffness and pain down the arms and hands.

Most patients tend to get better with medication and exercises. However occasionally the spondylotic changes can lead to compression of the spinal cord or the nerve roots and this may result in pain, numbness and weakness in the upper limbs (radiculopathy).

Cervical spondylosis is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). The treatment involves removal of worn out discs or bone spurs – depending on the underlying problem. If required the surgeon will fill the gap with a graft of bone or other implants made of metal combined with bone.

Patients have reported their symptoms as being as mild occasional backaches to chronic low back pain that is severe enough to limit their activities at work and play. The pain is typically mechanical in nature. This means the pain increases as more stress or load is placed on the low back. Bending, lifting, and twisting are the types of movement that may exacerbate DDD.

Management

Rarely does DDD require surgery. There are several non-surgical treatments including anti-inflammatory medication, physical therapy and exercise programs. Surgery is only considered when the patient’s symptoms are debilitating; interfere with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months. Fusion permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion for DDD is best when limited to one or two discs. Fortunately we have five discs in the lumbar spine. The un-fused discs take over to provide adequate function of the lower back.

An artificial disc can also be inserted into the space after removing the entire degenerated disc. This surgery is done from the front. This restores disc height, improves spine function, and helps to eliminate debilitating pain.