The Bonati Institute Glossary: Degenerative Disc Disease

The mission of The Bonati Institute is to provide hope to people suffering with chronic pain or Lumbar Degenerative Disc Disease from a back or neck condition. We believe that a well-informed patient is vital to restoring hope and finding answers to pain. We developed this web site primarily to help educate pain sufferers and their families. We've found that the more individuals in pain learn about their anatomy, their condition and the options available to them the more likely they will be to choose the advanced arthroscopic and Degenerative Disc Disease procedures offered by The Bonati Institute.

Definition of Degenerative Disc Disease (DDD)

Degenerative Disc Disease refers to a syndrome in which a painful disc causes chronic pain. The condition generally starts in the disc space. A weakened intervertebral disc can create excessive motion in the adjoining vertebral level because the disc cannot hold the vertebral segment together as well as it used to. The excessive motion and the inflammation inside the exposed disc irritate the local area and produce back pain. Unlike the muscles in the back, the disc does not have a blood supply and therefore cannot heal itself, leaving the painful symptoms of degenerative disc disease to become chronic. While it is rare that low back pain from degenerative disc disease will progress or increase, the pain will tend to fluctuate and at times may become significantly worse. It is important to note that disc degeneration is part of the natural process.

How Discs Degenerate

Long before Degenerative Disc Disease can be seen on an MRI, biochemical and histologic changes may have occurred. Some of these changes are not unlike those associated with osteoarthritis. Over time the collagen (protein) structure of the outer wall of the intervertebral disc, also called the annulus fibrosus, weakens and may become structurally unsound. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc’s inability to handle mechanical stress. Because the lumbar spine carries a large portion of the body’s weight the stress on the annulus fibrosus from motion may result in a disc problem (e.g. herniation).

Lumbar Degenerative Disc Disease

Lumbar Degenerative Disc Disease (DDD) is a gradual process that commonly compromises the lumbar spine. Degenerative changes in the lumbar spine often cause the loss of normal structure and/or function. The intervertebral discs in the lumbar spine are structures prone to the degenerative changes associated with wear and tear, aging, and misuse (e.g. smoking).

Cervical Degenerative Disc Disease

Degenerative disc disease is much less common in the cervical spine than in the lumbar spine because there is substantially less torque and force across the cervical spine. Sometimes, however, there is a twisting injury to the disc space that starts the degenerative cascade of degenerative disc disease and leads to chronic neck pain.

Surgical Treatment of Degenerative Disc Disease

The Bonati Arthroscopic Laser Discectomy

The procedure is designed as an answer to:

• Severe lower back pain with radiculopathy or radiation of pain into the legs
• Pain that has not responded to conventional treatments such as rest, analgesics, muscle relaxants and physical therapy after 3 months
• Pain from a herniated lumbar disc or discs that have been confirmed by MRI's, CT Scans and/or Myelograms
• Pain from previously failed open surgeries

Herniated discs that produce pain can be treated. The portion of the disc that is causing nerve compression can effectively be removed through a small incision. With the patient awake, a needle is placed into the area of the disc that is producing symptoms. A small incision is made on the patient’s back and the endoscopic tube is inserted.

Using specially adapted endoscopic instruments the diseased disc material is removed and then a laser vaporizes the surrounding problem tissue. A laser is then used to shrink and remodel the remaining disc. A small dressing is used to cover the incision.

Often patients feel immediate relief following this procedure. Rehabilitation begins within hours of surgery, and involves gait training, back or neck support, and walking. Post-operative pain management programs avoid narcotics in favor of a Transcutaneous Nerve Stimulator that blocks pain messages to the brain.

The benefits of this procedure:

• Fewer risks, local anesthesia, a small incision
• Minimal blood loss
• Short recuperation time
• Minimal damage to tissues
• Surgeries are done in an outpatient setting
• Patient sees a faster return to a normal lifestyle