Fig. 24

Surgical treatment options for degenerative changes. (a) Herniations. Herniations are often associated with pain and neurological symptoms and most commonly occur on the lumbar spine. Treatment options include conservative treatment if the herniation does not compress the nerves and surgical removal of the herniation if neural compression exists. (b) Spondylosis. Chronic longstanding disc degeneration results in slowly progressive mild-to-moderate disc space narrowing and gradual osteophyte formation without apparent disc displacement. Spondylosis is considered an adaptive reaction to stabilise motion in the presence of instability or a compensatory mechanism to limit the range of motion and prevent further degeneration. Altered disc biomechanics and narrowed intervertebral disc space subsequently lead to facet joint degeneration. This is probably the most favourable type of degeneration as it is essentially asymptomatic, may be seen at all levels of the spine and typically does not require treatment. (c) Disc collapse. Disc collapse leads to annular folding, anterior bulging of the flaval ligaments and posterior bulging of the posterior longitudinal ligament, with consequential narrowing of the central spinal canal. The decreasing disc height of the involved spinal segment leads to increased stiffness and may cause vertical degeneration of the adjacent vertebral segments. (d) Progressive structural failure of the disc to maintain the integrity of the functional spinal unit leads to segmental instability. This may progress to degenerative spondylolysthesis and require spinal instrumentation