Deterioration of the inner part of the disc tissue causes low back pain and is called degenerative disc disease. This situation is different from herniation of disc tissue (disc herniation). Radiologically, in MRI examination, the disc tissue may show signs of darkening (black disc) in T2 examinations, and as degeneration progresses, this darkening in the disc increases and a decrease in the disc height between the vertebrae is observed. It is a painful condition. It is generally at the single disk level. Diagnosis is made by clinical examination, MRI and discography.
If the painful process in degenerative disc disease continues for more than 6 months, and if the pain does not go away and persists despite physical therapy and epidural steroid injections, surgery may be necessary. Because low back pain, which occurs as a result of degenerative disc disease, is a disturbing condition that disrupts the 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 where the diseased disc is located, while preserving the disc tissue. In this way, the load on the degenerated disc will be eliminated or reduced, thus lower back pain will improve. It has been reported in the literature that the disc is preserved with this method and if there is a non-progressive disc disorder, there is radiological improvement in this disc tissue. The second method is fusion surgery. Here, the degenerated disc tissue is completely removed and replaced with bone tissue or cages, followed by fusion (freezing). Again, with this intervention, posterior stabilization is added to the surgery.
Disc herniations (herniated disc) are a separate situation. Here, the tissue called nucleus pulposus in the inner part of the disc tissue can tear the annulus and put pressure on the nerve tissues in the canal. Ultimately, it is a condition that results in loss of strength and/or sensation in the leg or foot. If there is a significant neurological deficit as a result of disc herniation (severe pain that does not respond to medical treatment, foot drop, urinary incontinence, loss of strength and sensation in both legs), urgent surgery may be required, but in other cases, treatment such as medication and physical therapy usually lasts for 4-6 weeks. If the methods are applied and there is no improvement or progress, surgery may be considered. Standard practice in surgical treatment is discectomy with microsurgical methods.
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