Surgical procedures for the treatment of lumbar degenerative disc disease include discectomies, laminectomies, spinal fusions and artificial disc replacements.
When patients fail to get relief from conservative, non-surgical treatments, it is time to consider some of the currently available surgical options. A surgeon can identify which procedure is best for each patient’s particular situation.
Minimally Invasive Discectomy
A minimally invasive discectomy helps relieve the patient’s pain by using small, precision instruments to remove a disc bulge or herniation that is pressing on a nerve root. Approximately 10–15% of patients who have a discectomy experience recurrent bulges or herniations sometime in the future.
Lumbar Laminectomy Procedure
Lumbar laminectomy is another surgical procedure to relieve pressure on spinal nerves. This surgery enlarges the spinal canal to provide additional room for spinal nerves by removing a section of bone covering the spinal canal and any existing bone spurs in the problem area. Approximately 70–80% of patients experience significant improvement after undergoing this procedure.
Lumbar Spinal Fusion Surgery
Lumbar spinal fusion is a type of surgery for degenerative disc disease that attempts to relieve low back pain by stopping motion at the injured disc segment. The procedure is called a fusion because it promotes the growth of bone to fuse sections of the spine together.
Spinal fusion surgery typically involves the removal of damaged discs, placement of a spacer cage in the resultant empty disc spaces and the use of hardware such as rods and screws or facet bolts to stabilize the spine. Surgery may also include a partial or full laminectomy and nerve decompression.
Bone growth is stimulated by the use of bone fragments taken from the patient’s hip during the surgery, cadaver bone or synthetic material known as bone morphogenic protein.
Fusion surgery can be an effective option to enhance a patient’s activity level and overall quality of life. Recovery periods for standard spinal fusion surgery can be 8–12 months or longer and is quite variable between patients. New minimally invasive techniques have decreased recovery periods and post-operative discomfort.
Resultant loss of motion in the fused disc segments tends to put additional stress on adjacent levels, thus causing patients to undergo more fusion surgery later in life.
Determination of the surgery’s success is dependent on one’s viewpoint. Surgeons typically consider the procedure a success once the fusion process is complete. Patients, however, only consider it a success if their low back pain has been eliminated.
Artificial Disc Replacement
Artificial disc replacement is a relatively new procedure to treat pain and disability from lumbar degenerative disc disease. Replacing damaged discs with artificial ones is supposed to maintain more of the lumbar spine’s natural motion, thus reducing the chance of adjacent spinal levels breaking down due to additional stress.
Since artificial disc surgery is still a new procedure, long-term efficacy, potential risks and complications from this procedure are still relatively unknown. New products and techniques are currently in development, but some studies indicate the possibility of needing to replace an artificial disc within 5–10 years of initial implant.
Complications From Lumbar DDD Surgeries
As with any major surgery, patients can experience numerous complications from the aforementioned procedures. Some of the more common complications include:
• Reactions to anesthesia
• Nerve damage
• Continuing pain
Every patient’s case is unique and it is best to discuss all aspects of a potential surgery, its side effects and complications with the surgeon.