Deterioration of the inner part of the disc tissue presents with low back pain and is called degenerative disc disease. This is different from herniation of the disc tissue (disc herniation). Radiologically, in MRI examination, the disc may show signs with black disc in T2 examinations, and when degeneration progresses, this darkening in the disc increases and a decrease in disc height between the vertebrae is observed. It is a painful condition. It is usually at the single disc level. Diagnosis is made by clinical, MRI and discography.
If the painful process continues for more than 6 months in degenerative disc disease, if the pain persists despite physical therapy and epidural steroid injections, surgery may be required here. Because low back pain as a result of degenerative disc disease is an uncomfortable condition that impairs quality of life. There are two preferred surgical treatment methods in the world today. The first is to apply posterior dynamic stabilization only between the vertebrae with the diseased disc while preserving the disc tissue. In this way, the load on the degenerated disc will be eliminated or reduced, and therefore the lower back pain will also improve. In the literature, it has been reported that the disc is preserved with this method and if there is an undeveloped disc disorder, this disc tissue is radiologically healed. The second method is fusion surgery. Here, however, the degenerated disc tissue is completely removed and replaced with bone tissue or cages, and fusion (freezing) is attempted. Again with this intervention, posterior stabilization is added to the surgery.
Disc herniations (lumbar hernia) is a separate situation. Here, the tissue that we call the nucleus pulposus in the inner part of the disc tissue can tear the annulus and press the nerve tissues in the canal. As a result, it is a picture that results in loss of strength and/or loss of sensation in the leg or foot. If there is a significant neurological deficit (severe pain that does not respond to medical treatment, drop foot, urinary incontinence, loss of strength and sensation in both legs) as a result of disc herniation, emergency surgery may be required, but in other cases, treatment such as medication and physical therapy for 4-6 weeks is usually required. methods are applied and if there is no improvement or progress afterward, surgery may be considered. The standard practice in surgical treatment is discectomy with microsurgical methods.
