Degenerative Disc Disease

The intervertebral spinal disc absorbs shock, accommodates movement, provides support, and separates the  vertebral bodies of the spine. The disc consists of a core (nucleus pulposus) and surrounding shell (annulus fibrosus).

Cervical disc disorders include herniated disc (herniated nucleus pulposus or HNP), degenerative disc disease (DDD), and internal disc disruption (IDD). HNP implies protrusion of disc material beyond the vertebral body. Most of the herniation is made up of the annulus fibrosus. DDD involves degenerative annular tears, loss of disc height, and core degradation. IDD describes annular fissuring of the disc without external disc deformation.

Cervical degenerative disc disease (DDD) most commonly is due to age-related changes, but the condition also is affected by lifestyle, genetics, smoking, nutrition, and physical activity. 

The disc begins to degenerate in the second decade of life. Circumferential tears form in the annulus after repetitive use. Several circumferential tears coalesce into radial tears, which progress into radial fissures. The disc then disrupts with tears passing throughout the disc. Loss of disc height occurs with subsequent peripheral annular bulging. Proteoglycans and water escape through fissures formed from nuclear degradation, resulting in further thinning of the disc space. Vertebral sclerosis and osteophytic formation ultimately follow. 

In the past degenerative disc disease  often lead to disc surgery to remove the disc and fusion of the vertebra. The resulting elimination of the natural range of motion often resulted in further damage to adjacent discs. This cervical disc surgery is called anterior cervical discectomy and fusion (ACDF).

Over the past 15 years a breakthrough disc surgery for Degenerative Disc Disease has been developed in Europe known as Artificial Disc Replacement (ADR) or Disc Arthroplasty. A disc prosthesis is implanted between the vertebra after removing the core of the damaged disc. Disc space is restored and range of motion is maintained limiting further damage. Disc Replacement can also be used to eliminate damage in adjacent discs where previous spinal fusion exists.

Disc Replacement or Disc Arthroplasty, as compared to other orthopedic disciplines, is the next evolutionary step in spine surgery. Disc Replacement surgery is now commercially available in Europe and many other countries. FDA trials are underway and should be concluded within the next few years, although many Americans have been going to Germany, to avoid Spinal Fusion and get their Artificial Disc Replacement surgery for years.     

Artificial Disc Replacement | Degenerative Disc Disease | Discectomy and Laminotomy | Discectomy with Fusion | Foraminal Stenosis | Cervical DDD

Internal Disc Disruption | Radicular pain of the neck |Treatment of Cervical Disc Disease | Jim's ADR story | SB Charite III | Lumbar DDD | Other Resourses