I Have Degenerative Disc Disease: Do I need Surgery?
One of the most common diagnoses that my patients present me with is degenerative disc disease, or DDD. I’m not sure exactly who came up with the name for Disc Disease, but it isn’t a disease. It’s just the result of wear and tear of the discs between corresponding vertebrae. It’s much more prevalent in the later decades of life. Think of it this way: A car with 200,000 miles has much more wear and tear than the vehicle on the showroom floor. In truth, it’s all about how you maintain your vehicle that dictates its longevity.
In life’s later stages, discs throughout the spine begin to lose hydration, which ultimately hinders their primary function as shock absorbers, and in turn, simple neck or back movements can become compromised.
To understand how DDD progresses, you must first understand the anatomy. An intervertebral disc, or IVD, is primarily made of up water and connective tissue, divided into an outer layer, and a soft inner layer. If the outer layer is weakened, the inner layer may travel or push through the compromised outer layer and affect surrounding nerves and the muscles they facilitate. This is known as a herniated disc, and why you experience pain that may travel into your shoulders or arms, hands, hips, legs, or feet, and may be accompanied by tingling and numbness and/or weakness.
Another problem that may arise as a result of DDD is known as foraminal stenosis, (foramen means opening, and stenosis means narrowing). This occurs when a small hole located on either side of the spinal canal becomes compromised, or enclosed, compressing nerves that travel through to innervate the surrounding musculature. Foraminal stenosis typically involves degeneration of the closest disc and the surrounding joints. Bony degeneration of joints is more commonly known as arthritis and can result in inflammation and additional, unwarranted formation of bone where it need not be. This process can inhibit movement and result in pain, tingling, numbness, and/or weakness that travels into the shoulders, hips and/or arms, legs, and feet as well.
If you are in the beginning stages of arthritis or DDD, surgery may not be your only option. Consult your physician and ask for all of your options. As of 2013, the Journal of the American Medical Association began recommending conservative care such as chiropractic, physical therapy (PT), massage therapy (MT), or acupuncture before undergoing much more invasive procedures. Unfortunately, I cannot say or promise that chiropractic, PT, MT, or acupuncture are going to be 100% effective, or even helpful at all depending upon the severity of your condition. It may help your 10/10 pain become 2 or 3/10, or even 1/10, but in comparison to surgical outcomes, 30% – 40% of surgical patients experiencing the aforementioned diagnoses experience continued pain, or worsening of symptoms within 12 months following surgery.
Before you think I’m telling you that surgery is the worst thing that could happen, it isn’t. If you do choose to see a chiropractor, physical therapist, message therapist, or acupuncturist, make sure you have a plan. There should be regularly scheduled re-evaluations and measures to thoroughly track your progress. If little to no progress is made within the first 4 – 6 weeks of care, then more invasive treatment such as surgery may be your next step. At that point, at least you’ll know that you tried everything possible before undergoing a procedure that cannot be reversed. Surgical intervention as can be an ineffective treatment, but there’s also a time and a place for everything, from pain medication, injections, radiographic imaging, to spinal fusions. I’ve had to refer patients for all of the aforementioned, based upon betterment of their health, in conjunction with support from current, evidence-based research. However, the complications associated with surgery vastly outweigh that of conservative care as a first choice. Post-surgery, there’s risk of further progression of degenerative changes (new onset of foraminal stenosis, new/recurrent disc hernations), formation of scar tissue, altered biomechanics that result in increased load on adjacent joints, increased muscular tension, atrophy, or spasming. Inaccurate diagnosing is a major factor leading to failed back surgery (FBS), with as much as 58% of FBS resulting from undiagnosed foraminal stenosis of the lumbar spine. Certain diagnoses are associated with greater rates of FBS. For example, multiple studies have shown that back pain caused by foraminal stenosis is associated with greater rates of FBS than pain caused by recurrent disc herniation.
In fact, one of the more recent reviews in the Journal of Manipulative and Physiological Therapeutics, conducted clinical trials revealing significant improvement following consistent spinal manipulation (chiropractic adjustments) over the course of one year. As part of the review, JAMA researchers reviewed nine previous studies, revealing significant pain-level improvements following regular spinal treatment. Across all trial groups, including 529 patients that received a total of 4891 treatments, it was found that their pain-levels remained significantly improved up to 4 months post-treatment (16 months later). Evidence-based applications as a result of this study, revealed that approximately half of participants with pain ranging from mild-moderate pain recovered as early as their fourth visit from their initial treatment, whereas approximately two-thirds of patients with moderate-severe pain recovered at 3 and 12 months duration. Fifty-one percent of participants did experience an adverse event after any of the first few treatment sessions, typically consisting of either mildly provoked musculoskeletal or pain related symptoms. Only 5 subjects (~1%) reported to be worse at 12 months follow-up. Although adverse events are common, it was found that many patients experience quick dissipation of any provocation shortly after initial care has begun, and with continued care, many benefit in the long run. For the participants in this particular study, the benefits of conservative chiropractic care seem to outweigh the potential risks.
Michael “Dr. Mike” Roney, D.C., is a musculoskeletal specialist who recently joined Pawling Family Chiropractic, located in the Atrium on Route 22. He can be reached at (845) 855-1475 or at FellaWellness.com online.