Degenerative Disc Disease Diagnosis &Treatments
How Do We Diagnose Degenerative Disc Disease and Annular Tear?
Accurate and thorough diagnosis is key to selecting the best treatment options. The following is part of a 3 Step comprehensive diagnostic workup:
- Complete Medical History And Physical Examination: Assessment of symptoms, previous treatments and care. A careful examination by a spine specialist for limitations of movement, problems with balance, and pain. The examination should also cover loss of reflexes in your extremities, muscle weakness, loss of sensation or signs of spinal cord damage.
- Diagnostic Testing: Generally, plain x-ray films are taken which allows the physician to assess for instability and to rule out other problems such as infections. CT scans and MRIs are often used to give them a three-dimensional view of the lumbar spine, the disc, spinal cord and exiting nerves. The MRI can help detect herniated discs, foraminal stenosis, sciatica, bone spurs and compression of the spinal cord and exiting nerves.
- Discography Injection: The patient is consciously sedated and comfortable. A needle is placed into the disc through X-ray guidance and a contrast medium is injected into the suspected disc to diagnose a degenerative and painful disc. The patient being under conscious sedation can confirm the pain they typically suffer from to the injection.
What Are The Treatment Options?
Treatment for degenerative disc disease ranges from conservative therapies to surgical intervention. The goals of treatment are to relieve pain, prevent or reduce stress on the discs or spinal nerves and maintain normal function. It is almost always recommended that the patient be prescribed non-surgical, conservative treatment initially to help relieve symptoms.
- Medications: anti-inflammatories, muscle relaxers and, on rare occasions narcotic medications
- Heat/cold therapy: during the first 24-48 hours
- Physical therapy exercises: including stretching, massage, and strengthening
- Epidural steroid injections: are used two-fold; first to relieve inflammation of the affected spinal nerve, and secondly diagnostically to confirm the correct affected level from which the pain originates.
Least Invasive Spine Procedure
Once conservative measures have been exhausted and the patient is still in considerable pain after 3-6 months then surgery is recommended. The following procedure has shown great results in minimizing in most cases and alleviating pain altogether in some cases:
- Endoscopic Discectomy: A ¼ inch incision is made and a 7mm operating tube is placed in the disc at the site of the annular tear. An endoscope with an HD camera is inserted into the operating tube to visualize the annulus and spinal nerves. Then the tear is debrided to make sure no nucleus pulposus is stuck within the annulus and thermally heated with bipolar instrument to reduce and close the tear.
Minimally Invasive Spine Surgery
- Microdiscectomy – Usually an open procedure or using tubular retractor with an incision of 1 inch. The surgeon usually observes through a microscope or set of eyeglass loupes that help magnify the anatomy. Most of the pain post-operative is from the approach the surgeon made through muscle in your back. Anesthesia is necessary.
- MIS TLIF – The surgery using a minimally invasive surgical approach, involves removing the damaged or degenerative intervertebral disc, and replace it with a donor bone or PEEK cage packed with donor bone to assist in union or fusion of the two vertebral bodies over time. Screws are used to hold the disc still until it fuses.