Degenerative Disc Disease - Is Surgery or Rehabilitation Better?

Degenerative disc disease involves deterioration of one's intervertebral discs. The disks are the soft tissue areas between the bony vertebrae and act as shock absorbers for the spine. There is one at every level of the spine. There are nerve endings in the outer region of each disc, so if the degeneration involves this area pain may flare up from an irritated nerve ending. One's resulting pain may wax and wane for years, or unfortunately it may end up kicking in and then never going away.

The pain from degenerative disc disease is very challenging to treat. Why? The reason is that interventional pain treatments have been developed for this anatomical area, but just have not worked very well. Intradiscal electrothermal treatment along with steroid injections have not shown substantial benefits. There has been a lot of research into developing a biologic treatment or maybe a soft tissue insert for pain relief, none of which have succeeded yet. So does surgery give better results than non-operative rehabilitation efforts?

Surgery for degenerative disk disease has 2 options currently. One is a spinal fusion. Spinal fusions for degenerative disc disease have shown anywhere from a 50% to 75% success rate. When artificial discs were invented and FDA approved back in 2004 here in the US, studies were done looking at them versus spinal fusion. Results showed equivalency - no better, no worse. Interestingly, over half of patients who have either an artificial disc replacement or a spinal fusion remain on narcotics over a year after surgery. So pain remains an issue post-operatively.

A recent study out of Norway compared patients with degenerative disc disease who either had received chiropractic treatment and physical therapy and behavioral treatment versus an artificial disc replacement. The patients were followed for 2 years. Which group did better? They actually fared the same, with no differences being seen in either return to work, life satisfaction, fear avoidance beliefs, or drug use.

Both groups received significant pain relief, and statistically speaking the surgery patients did better on their disability index scales along with some secondary outcomes. Clinically speaking though, the results were equal.

Surgery for degenerative disc disease should not be taken lightly. At times the results may be considered a "home run" and for others the pain relief ends up marginal. This research showed that non-operative treatment did as well clinically as surgery, but avoided the risks, disrupted lives, and expense associated.