Spinal decompression is the removal of pressure on nerve roots and nerves in the spinal column and it is by far the goal of most therapies, both conservative and surgical. This pressure/compression causes pain and in more severe cases can cause dysfunction of the limbs, bowels and sexual functions. In the most severe cases where pressure is high in the cervical spinal canal on the spinal cord, compression can even cause death. The question for the patient and the medical professionals, who serve them, is what is the best method to achieve decompression?
The method to choose for decompression depends on what is causing the compression. Spinal discs, bone spurs (osteophytes), enlarged ligaments and tumors are all possibilities. Hence, a spinal surgeon should not be limited in surgical techniques in the treatment of the patient.
The diseased spinal disc is the most common causes of nerve compression in the spine. Disc desiccation with disc height loss, disc bulges, and disc herniations can all lead to nerve compression in the spinal canal and the neuroforamen. Disc height loss can also cause pressure on the nerves in the facet joints and lead to arthritis in the facet joints, which are part of the vertebrae, but are posterior to the spinal cord, unlike the discs which are anterior to the spinal cord. All of these conditions are associated with degenerative disc disease (DDD).
To date removal and replacement of the disc is most often required to alleviate the pain. Both fusion and artificial disc replacement achieve these two goals. However as we seen clearly today in knee and hip replacements, a movable join is much more desirable than a fused joint, which was the prior treatment for bad hips and knees. For those unfamiliar with anatomy the intervertebral disc is a movable joint between two bones and allows for a flexible lumbar spine and neck.
The patient should know that ninety percent of all disc herniations are reabsorbed by the body within six months. However, many of these herniations are not problematic as they do not compress nerves, and unless the herniations are causing a large amount of pain or dysfunction, surgery should not be considered .
Aside for spinal compression, it should also be mentioned that DDD can generate pain from the annulus of disc. This is called discogenic pain. Discography is often used to verify discogenic pain and was first verified in medicine in the mid 1990s.