You may have heard of the term, ‘degenerative disc disease.’ This term doesn’t actually refer to a disease, but instead to a condition in which a damaged spinal disc causes pain.
Let’s take a quick pause to review the role that discs play in your spine. Your spine is made up of a series of bones that run from the top to bottom of your back. Discs sit between each of these bones. They serve as shock absorbers and provide flexibility for your spinal column. Normally, each of your discs is directly adjacent to your spinal nerves.
We should also bring up ‘facet joints.’ Facet joints are the connections between the bones of the spine. Thus, the spinal bones, discs, facet joints and nerves all function together to enable our mobility along with far more complex body functions.
Ok, now that we have that in mind, what exactly is ‘degenerative disc disease?’ This condition is the progressive deterioration of spinal discs and arthritic changes in facet joints due to wear and tear with aging. Bone spur overgrowth can also cause a narrowing of the spinal canal, resulting in spinal stenosis, where the nerves running up that canal are compressed. This causes pain, numbness, and weakness in the legs.
There are a host of additional conditions associated with degenerative disc disease, including lumbar radiculopathy (also known as sciatica), neurologic claudication, and degenerative spondylolisthesis. They all are part of the challenges we face as we age and work to remain active in our lives.
Treatments in the Past
Until recently, the only options to treat degenerative disc disease other than non-operative pain management have been surgical intervention and artificial disc replacement.
Traditionally, patients with degenerative disc disease often underwent discectomy and laminectomy surgeries. That means that the surgeon removes part of the bulging disc and part of the bone around the spinal canal.
The problem with this procedure is two-fold. The removal of the disc material just weakens the disc, so there is a risk for the disc to re-herniate. In addition, the removal of bone can make the segment more unstable. Hence, pain can return and when it does, that’s called “Failed Back Surgery Syndrome.”
To try and fix these issues, surgeons began performing spinal fusion. The concept was that since pain is often caused by spine instability due to degeneration along with a loss of the height of a disc, a spacer along with hardware would be inserted to prop the disc up. The thought followed that since that spine segment would not move at all, the pain would go away.
However, after spinal fusion, when one segment no longer can move, more force is exerted on other parts of the spine to compensate. The result? New issues crop up along adjacent parts of the spine due to the increased stress and often, new sources of pain are created.
To solve these problems, artificial disc replacement (ADR) emerged as an alternative. The idea behind this was rather than fuse two spine segments, an artificial disc would allow motion and prop up disc height – alleviating the problems with fusion.
The ADR technique however has similar issues to spinal fusion surgery, as the motion of an artificial disc joint isn’t natural. Increased stress on adjacent segments of the spine still occurs as it does with spinal fusion. Research has shown that there is little difference in outcomes between artificial disc implantation and fusion surgery.
Alternatives to Spine Surgery?
We regularly see patients who are experiencing new problems after undergoing spinal fusion surgery or artificial disc replacements. But what are the alternatives other than living with the pain?
The results of epidurals are hard to predict because the procedure inserts medication behind the disc. Steroids into the disc itself usually don’t provide lasting relief.
There are two alternatives that have emerged however that may be appropriate for some patients: VIA Disc and the Intracept Procedure.
VIA Disc is a novel approach to address degenerated discs is to rebuild the disc biologically. In recent years, advances in regenerative medicine have advanced dramatically. They have taken their cue from the fact that the human body has a natural ability to heal itself in many ways. For example, skin cuts repair themselves, broken bones mend, and donated liver transplants regenerate.
Orthobiologic regenerative medicine is focused on taking this natural ability, directing it, and helping it along. The VIA Disc procedure uses biologic growth factors and cytokines extracted from intervertebral discs that are enhanced with additional solutions to promote this therapy’s effectiveness. It supplements tissue and cell loss that is associated with degenerative disc disease in the lower back.
During an outpatient, non-surgical procedure, this mixture is injected into degenerated discs under imaging guidance with moderate sedation. The goal is for this supplement to support the regeneration of the disc itself – and improve its functionality. Studies have shown that those treated showed pain and function improvements that continued to be evident 12 months after the treatment.
Another option that has recently emerged is the Intracept Procedure.
Referencing back to our opening discussion about spine anatomy, at the point where discs meet the vertebrae bone that they are cushioning is a layer called the vertebral endplate. This endplate is a mix of cartilage and bone that separates these two elements of your spine.
Research has shown that for some, back pain specifically originates in one or more of these endplates. And if this is the source of your back pain, there is a new innovative way to treat it that doesn’t disturb the delicate function of your discs.
There is a nerve called the basivertebral nerve that interfaces with your vertebral endplates. The Intracept Procedure is a minimally invasive procedure that targets the basivertebral nerve to provide relief from chronic how back pain that originates in a vertebral endplate.
This outpatient procedure is implant-free and preserves the structure of the spine. It ablates the basivertibral nerve with a radiofrequency probe to provide lasting pain relief.
Are You a Candidate for Either of These Procedures?
While both VIA Disc and the Intracept Procedure show promise to address chronic back pain developed as a result of degenerative disc disease, they are only appropriate for some patients. If you are interested in finding out more and if you are a candidate, schedule an appointment to talk to your Main Line Spine doctor.