Frequently Asked Questions
Have questions? You will find the answers to some of the most frequently-asked questions about the spine, related conditions, and treatments.
DDD stands for Degenerative Disc Disease and is one of the most common causes of neck and back pain. It refers to the breakdown of one or more discs (shock absorbing soft tissue structure between each vertebra) in the spine and is linked to neck or back pain with or without shooting pain, numbness and weakness in the arms or legs.
DDD isn't really a disease but a way to refer to the natural breakdown of spinal discs over time. DDD can lead to a loss of disc height that may cause pain, numbness or weakness in the back, arms or legs.
Yes. Sometimes, an injury causing severe damage to spinal discs can disrupt them causing a disc to bulge, stick out or lose height, regardless of the aging process.
There are several risk factors for getting DDD. The most common one is aging, as DDD is a natural, age-related process. Some other risk factors are: traumatic injury, being over weight, playing contact sports, heavy lifting and repetitive motions involving the back.
The symptoms of DDD may include back pain with or without arm or leg pain as well as arm or leg weakness, tingling or numbness. DDD pain often gets worse with movement like bending or twisting. Only a licensed spine specialist can accurately diagnosis a spinal condition, like DDD.
DDD diagnosis starts with a standard questionnaire that details the patient’s symptoms and where they occur. Then, a spine specialist performs a routine physical exam of the back, arms, hands, legs and feet while testing for strength, flexibility, range of motion, reflexes and pain.
The spine specialist may also order some tests, like a bone scan, discogram/discography or myleogram to assist in the diagnosis.
- Bone Scan: A bone scan can be used to identify health concerns like osteoarthritis, fractures or infections. It is a non-invasive test where a small amount of radioactive medicine is injected into the blood and then absorbed by the bone. More of the medicine will be absorbed in bony areas that are abnormal or problematic. A scan of the spine is then taken and the areas where the medicine has been absorbed will be seen as hot spots and light up on the scan. These hot spots identify where the problem maybe in the spine.
- Discogram or discography: A test to determine if a specific spinal disc is causing pain or other discomfort. A discogram/discography is a non-invasive test where a medical dye is injected into a suspected problem disc and an x-ray is taken. If the dye stays within the disc space then, the disc is normal. If the dye leaks out, then the disc has a problem, like a herniation or bulge. The test pinpoints the problem disc for the spine specialist to treat.
- Myelogram: A myelogram is a non-invasive test to determine if the problem is with the spinal cord or in the spinal canal (the bony opening surrounding the spinal cord). A medical dye is injected into the spinal canal and then an x-ray or CT scan is taken. The scan or image will show a detailed picture of the spine and surrounding bones and nerves. By reviewing the scan, the spine specialists can identify any abnormalities or problem areas.
In addition to these tests, the specialist may also order x-rays, computerized tomography (CT) scan or magnetic resonance imaging (MRI) to get a visual understanding of the spine and associated abnormalities or areas of concern. A CT or MRI shows the soft tissue of the spine, not just the bones like an x-ray, so the spine specialist can identify the location and nature of the problem causing discomfort.
There are many nonsurgical treatments for DDD. Some of the nonsurgical treatment options that may be discussed with a doctor are: pain management, bracing and physical therapy, among others. Only once these non-surgical treatments have been utilized will your physician or surgeon likely discuss surgical options.
There are many nonsurgical treatment options that should be considered prior to making the decision about spine surgery. Spine surgery should be the last option. The more conservative, nonsurgical treatments for back pain and associated arm and leg pain include physical therapy, bracing, pain management and many other options. Only once these conservative treatments have been utilized will your physician or surgeon likely discuss surgical options.
There are many surgical solutions for treating DDD depending upon a patient’s diagnosis, physical condition, surgeon’s training and many other factors. Your surgeon will discuss the options that are available for your situation. One of those options may include an anterior fusion surgical procedure called Total Disc Replacement (TDR) or Anterior Cervical Discectomy Fusion (ACDF) for neck (cervical) conditions, Anterior Lumbar Interbody Fusion (ALIF) or Lateral Lumbar Interbody Fusion (LLIF) for low back (lumbar) conditions.
A disc replacement surgery is performed to resolve pain or discomfort in the back, neck, or extremities due to a diseased or degenerated spinal disc or discs. The procedure should be performed by a spine surgeon and can be done in a hospital or surgery center.
The goal of disc replacement surgery is to remove a diseased, often dehydrated disc and replace it with a device that enables motion within the diseased segment of the spine. By removing the diseased disc and implanting a disc replacement, your surgeon can remove the source of pain or discomfort generated from a nerve that is being pinched or compressed.
To perform a disc replacement, the surgeon will approach the spine from the front (anterior).
Once at the location of the degenerated disc, the surgeon will remove the problem disc along with any other areas of concern and replace it with a spinal device to restore the height of the disc space, which usually frees a pinched or compressed nerve. The implanted spinal device is designed to support the body’s natural healing process to achieve solid fixation between the device and the bone.
A spinal fusion is a surgical procedure performed to resolve pain or discomfort in the back, arms or legs due to a degenerated spinal disc or discs. The procedure should be performed by a spine surgeon and can be done in a hospital or surgery center.
The goal of spinal fusion surgery is to eliminate the motion between two or more vertebrae, the bony segments or bodies of the spine. This motion is often the source of the pain or discomfort generated from a nerve that is being pinched or compressed.
The spine surgeon attempts to eliminate the motion by fusing or joining two or more vertebrae together through the natural healing process that is supported by spinal devices, like interbody cages, bone graft substitutes, pedicle screw systems and many other similar type medical products.
To perform a spinal fusion surgery, the surgeon will approach the spine either from the front (anterior), side (lateral) or back (posterior). The approach the surgeon takes is based upon the diagnosis, patient comorbidities (other medical conditions), surgeon’s preference, education and training.
Once at the location of the degenerated disc(s), the surgeon will remove the problem disc(s) along with any other areas of concern and replace it with a spinal device to restore the height of the disc space, which usually frees a pinched or compressed nerve. The implanted spinal device will also support the body’s natural healing process to achieve a fusion between the adjacent vertebrae. In addition, the spine surgeon will also implant screws or other fixation devices to restrict the motion at the surgical site to aid the healing process as well.
Spinal fusion surgery duration varies depending on a number of factors: patient’s health condition, number of discs being treated, surgical approach, etc. After the procedure, the patient can expect to be in the hospital for up to five days and recovery can take up to eight weeks. The spine surgeon will review the surgery specifics and recovery expectations with the patient prior to the surgery.
In many cases, spine surgery may be performed as an outpatient procedure. This depends on the patient’s diagnosis, the surgical procedure, physical condition, surgeon’s training and many other factors. Your surgeon will discuss the options that are available for your situation.
An Anterior Cervical Discectomy and Fusion (ACDF) procedure is a cervical (neck) spine surgical procedure that is performed from the front of the neck. During an ACDF procedure, the surgeon will remove the degenerative or diseased disc(s) and replace it with an interbody device, to assist in stabilizing the spine, restoring disc height and assisting with fusion or healing of the neighboring vertebral bodies so they grow together.
An Anterior Lumbar Interbody Fusion (ALIF) procedure is a lumbar spine surgical procedure that is performed from the front of the body through the lower part of the stomach. During an ALIF procedure, the surgeon will remove the degenerative or diseased disc(s) and replace it with an interbody device, like STALIF Lumbar, to assist in stabilizing the spine, restoring disc height and assisting with fusion or healing of the neighboring vertebral bodies so they grow together.
The time to complete a total disc replacement or an ALIF procedure depends on a variety of factors including the number of discs that require treatment, whether or not this is a reoperation and the severity of the condition. The surgeon should give you a general idea about surgical time.
A Lateral Lumbar Interbody Fusion (LLIF) procedure is a lumbar spine surgical procedure that is performed from the side of the body through the abdominal muscles. During a LLIF procedure, the surgeon will remove the degenerative or diseased disc(s) and replace it with an interbody device, to assist in stabilizing the spine, restoring disc height and assisting with fusion or healing of the neighboring vertebral bodies so they grow together.
The time to complete an LLIF procedure depends on a variety of factors including the number of discs that require treatment, whether or not this is a reoperation and the severity of the condition. The surgeon should give you a general idea about surgical time.
The length of hospital stay after surgery varies by procedure and patient. Typically, a patient may be discharged as early as the same day of surgery or as long as three days after surgery. Your surgeon should provide a general idea about the length of hospital stay.
The decision to go back to work should be discussed with your surgeon and decided on an individual basis. It will be based upon the type of surgical procedure performed, the results of the surgery, the type of work the patient performs, etc. Typically, a patient will return to work within one to six weeks after spine surgery, although full recovery may take up to eight weeks. Your surgeon should provide a general idea about when you can expect to return to work.
Recovery from spine surgery varies by patient and procedure. Most patients will return to their usual life activities (work, sports, shopping, cooking, etc.) within six weeks after spine surgery. For some patients, this may take longer. Your surgeon should provide a general idea about recovery time.
Many patients benefit from physical therapy following spine surgery. Only a spine surgeon can recommend physical therapy following spine surgery. Please ask your surgeon about physical therapy, the type they recommend and for how long.
Lumbar Decompression Surgery is a procedure that is performed to alleviate pain caused by pinched nerves in the lower (lumbar) spine. The purpose of the surgery is to improve symptoms like severe pain and numbness of the legs that are caused by pressure on the nerves in the spine. It is commonly used to treat Spinal Stenosis, Sciatica, a slipped disc, and spinal injuries.
During lumbar decompression surgery, a portion of the bone over the nerve root and/or disc is removed to give the nerve root more space and provide a better healing environment.
Yes, Lumbar Decompression can be done minimally invasively. The procedure is referred to as M.I.L.D. (Minimally Invasive Lumbar Decompression). M.I.L.D. is a safe minimally invasive treatment that is a new therapeutic option to relieve pressure on the spine (lumbar decompression). This procedure can help reduce lower back and leg pain and increase mobility for patients diagnosed with lumbar spinal stenosis (LSS).
Spinal Cord Stimulation is a type of therapy that masks pain signals before they can reach the brain, essentially stimulating the spinal cord to manage chronic pain. It is a therapy that is used to help reduce pain symptoms and the use of opioid medications. This therapy is commonly an option for people who suffer from chronic back, leg, and/or arm pain who have not found relieve with other procedures.
With Spinal Cord Stimulation, a small device, similar to a pacemaker, is implanted in the body to deliver electrical pulses to the spinal cord.
Kyphoplasty is considered a minimally invasive surgery because it is performed through a small skin puncture rather than a larger (open) incision. A typical kyphoplasty procedure, described below, takes 1 to 2 hours per vertebral level to complete.
Complexity in spine surgery is a relative term, but it generally refers to surgical cases that involve one or more of the following:
- Revision of prior back or neck spine surgery
- Surgery across more than three spinal segments (or levels)
The sacroiliac joint (SI joint) is located in the pelvis; it links the iliac bones (pelvis) to the sacrum (lowest part of the spine above the tailbone). It is an essential component for shock absorption to prevent impact forces from reaching the spine. Many problems can cause sacroiliac joint pain, and, fortunately, various types of SI joint treatment are available.
In traditional spine surgery settings, a Foraminotomy is a major open back surgery meant to treat foraminal narrowing which requires an incision the length of the desired operable area in order to access each vertebral level experiencing compression of the nerves.