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Spondylosis

Degenerative Disc Disease (DDD) or Spondylosis refers to the gradual deterioration of the disc between the vertebrae in the backbone. This disease is very common, and affects as much as 40-50% of people over the age of 40. The disorder also becomes increasingly common as we age. It is a disease of wear and tear similar to osteoarthritis. It commonly happens in the lumbar spine (low back), though it can occur at any spinal level.

In DDD, the discs get flattened, losing their normal height. This disc height is what separates the disc above from the one below. Nerve pathways may become narrowed and cause nerve impingement, inflammation, and pain, when the disc height is lost.

Degenerated discs become much thinner and sometimes the vertebrae also develop small, rough areas which irritate the nearby nerves. Severe neck pain and stiffness and pain down the arms and hands can result from this .

Medication and exercises are the first line of management.

Cervical spondylosis is a very common condition where there is chronic degeneration of the bones of the neck (cervical spine) and the cushions between the vertebrae (inter vertebral disc). This is managed by cervical spine surgery where the worn out discs or bone spurs are removed - depending on the underlying problem. Sometimes the gap would be filled by a graft of bone or other implants made of metal combined with bone.

Symptoms of spondylosis may be as mild as occasional backaches or could be chronic low back pain that is severe enough to limit daily activities. The mechanical type of pain increases as more stress or load is placed on the lower back. Bending, lifting, and twisting are the types of movement that may exacerbate it.

Management

Degenerative Disc Disease requires surgery only rarely. The commonly used non-surgical treatments include anti-inflammatory drugs, physiotherapy and exercise programs. Surgery is required when the patient has very severe debilitating symptoms; pain interferes with activities of daily living, and non-surgical treatment has failed after a reasonable period of time, usually at least six months.

Fusion surgery is usually done and this permanently stops the motion of the spine at the level of the degenerated disc. This helps to relieve pain. Fusion surgery works best when limited to one or two discs. As we have five discs in the lumbar spine, the un-fused discs take over to provide adequate function of the lower back.

Sometimes an artificial disc can also be inserted into the disc space after removing the entire degenerated disc. This helps to restore disc height, improve spine function, and ease the debilitating pain.

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