Ask the Spine Surgeon
February, 2015 - Issue #124
Q: I've been diagnosed with degenerative disc disease. While this serious diagnosis is upsetting, I feel better knowing that my pain has a name - and potential solutions. My doctor suggested spinal fusion, but I'm concerned about limiting my mobility. I'm active, despite my pain, and only 53 years old. I'm very curious about artificial disc replacement. It seems like a much better option for me, considering my age and desire to maintain my active lifestyle. Can you tell me more?

A diagnosis of degenerative disc disease (DDD) is rarely welcome, but I understand your position: it is nice to know that significant pain in your neck or lower back at least has a cause that can be remedied.

DDD is most commonly marked by dehydrated, brittle degeneration that leads to discs flattening out and developing cracks in their outer layer. This causes pain because nerve fibers can grow into the cracks, or the now-flatter disc can come into contact with nerves or pain receptors. Parts of the disc's core can also bulge out, pushing on nerve fibers.

In the past, patients suffering from DDD traditionally opted for spinal fusion, a procedure that immobilized the painful disc. By fusing two or more vertebrae, the abnormal stresses experienced at the damaged-disc site are mitigated. The primary downside of this treatment, of course, is that fused discs are dramatically limited in their range of motion. As an active middle-aged person, I don't blame you for trying to avoid surgery that would limit your movement.

A secondary detraction is that spinal fusion surgery can, in some cases, be more invasive than a more current option: artificial disc replacement.

The FDA has approved artificial disc implants, which mimic the complex joints that exist naturally in the spine. Capable of parroting the multi-plane motions of a healthy disc, these state-of-the-art implants can help patients relieve pain while maintaining their desired activity levels.
Years ago, I was the first spinal surgeon to perform an artificial disc replacement procedure in Ventura County.

By combining artificial discs with dramatically-less-invasive surgical methods, I'm able to release my patients the same day of surgery. They're up and walking the next day and back to normal levels of activity within weeks, not months. Every patient has reported that they have been able to return to their desired level of activity post-surgery.

Based on your surgical goals, I would say that an artificial disc replacement is a better match than spinal fusion.

All this talk of surgery, though, is being had without certainty that you really need it. Without seeing your scans, I can't say for certain. What I can say is that I prefer to exhaust all conservative measures before identifying what surgical treatment option has the best outcome potential for each unique individual. Intensive rehabilitation can, in many cases, take surgery off the table entirely. If you're still able to remain active despite your pain, surgery may not be warranted. There are remarkably-effective non-surgical options available that may be right for you.

Kapil Moza MD, FACS
Diplomate, American Board of Neurological Surgery
Dr. Moza's Santa Clarita office is conveniently located on Lyons Avenue. 805-497-3622
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