Degenerative Disc Disease

It’s important to distinguish that the word “degenerative” refers to the changes in the intervertebral discs and doesn’t mean that the pain will keep getting worse over time.

The vertebral column (backbone) is made up of 33 vertebrae. Between each vertebra is a fibrous disc with a softer cartilage core, called an intervertebral disc.

In a healthy spine, these intervertebral discs cushion the vertebra like shock absorbers. They provide height and allow the spine and back to bend, flex, and twist.

A healthy, well-hydrated disc contains a large percentage of water which provides cushioning and flexibility for the spine. Much of the mechanical stress caused by everyday movements is transferred to the discs within the spine. Their water content allows them to effectively absorb shock.

As people age, it is normal for these discs to also age and change. They may dry out, thin, or crack. The soft cartilage core may bulge or herniate out through the fibrous outer portion of the disc.

Water loss makes the discs less flexible and results in the gradual collapse and narrowing of the gap between the vertebra. As the discs shrink, the two vertebrae above and below the affected disc begin to collapse upon each other, the facet joints at the back of the spine are forced to shift which can affect their function, or the disk can herniate.

Aging and other factors can cause discs to degenerate:

• The drying out of the disc. As we age, the disc dries out and doesn't absorb shocks as well.
• Daily activities and sports can cause tears in the outer core of the disc.
• Injuries can cause swelling, soreness, and instability.

Degeneration is normal and does not necessarily cause pain. Most people’s intervertebral discs degenerate over time. By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels. By the age of 60, more than 90% of people will show evidence of some disc degeneration.

Painless degeneration is just called degeneration. The term “degenerative disc disease” describes disc degeneration that causes pain and other symptoms.

Additionally, the body can react to the closing gap between vertebra by creating bone spurs around the disc space in an attempt to stop excess motion. This can cause issues if the bone spurs start to grow into the spinal canal and put pressure on the spinal cord and surrounding nerve roots as it can cause pain and affect nerve function. This condition is called spinal stenosis.

Degenerative disc disease can cause pain, weakness or numbness. Exact symptoms may vary depending on the location and type of disc degeneration, but the primary symptoms include sharp and/or chronic pain in the back and neck.

Whether a patient experiences pain or not largely depends on the location of the affected disc and the amount of pressure that is being put on the spinal column and surrounding nerve roots.

Symptoms occur most commonly in the low back or neck and include:

• Pain that ranges from nagging to severe and disabling
• Pain that affects the low back, buttocks, and thighs
• Pain in the neck that may radiate to the arms and hands
• Pain that is worse when sitting, bending, lifting or twisting
• Pain that lessens when walking and moving
• Pain that lessens with changing positions often or lying down
• Periods of severe pain that come and go, lasting from a few days to a few months
• Numbness and tingling in the extremities
• Weakness in the leg muscles or foot drop may be a sign that there is damage to the nerve root

It is important to note that the amount of degeneration does not correlate exactly with the amount of pain patients experience. Many people experience no pain while others, with the same amount of damage, have severe, chronic pain.

Diagnosis of degenerative disc disease will usually consist of an analysis of a patient's individual medical history including the circumstances of when and where the pain started, a physical exam designed to reveal muscle weakness, tenderness or range of motion, and an MRI scan to confirm the diagnosis and rule out other causes.

If a patient presents with symptoms associated with degenerative disc disease, the surgeon may order the following tests:

• X-rays – although X-rays cannot show soft tissue like discs, they provide details of the bone structures in the spine.
• Magnetic resonance (MR) imaging – this type of scan provides a detailed image of discs, allowing surgeons to see how the nerves and spinal canal space are affected by degenerative disc disease.
• Computed tomography (CT) scan – provides a detailed image of bone structures in the spine and is a great option for those patients who cannot undergo MR scans (for example, those who have a pacemaker or who have specific types of metallic implants.)

Treatment for degenerative disc disease will depend on the severity of the condition. Often, degenerative disc disease can be successfully treated without surgery. Before considering any surgical options, the doctor may employ any of the following treatments, alone or in combination:

• Heat and/or ice therapy
• Activity modification
• Anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs
• Oral pain and/or steroid medications
• Physical therapy (with the focus of strengthening the muscles of the back/neck and improving flexibility and range of motion)
• Spinal mobilization or traction
• Epidural injections of steroids or pain medication

For the most part, these nonoperative measures are effective in providing pain relief.

However, surgery may be required for some patients, including those:

• Who has not responded to nonoperative measures
• Who have a structural abnormality that can be effectively corrected
• With chronic severe pain
• Who have spinal cord compression (In these cases, patients usually experience nerve deficits and/or loss of bladder and bowel control)

There are many surgical options for the treatment of degenerative disc disease, including:

• Anterior cervical discectomy and fusion: A procedure that removes one or more intervertebral disc(s) replaces a small plug of bone or other graft substitutes that, in time, will fuse the vertebra.
• Cervical corpectomy: A procedure that removes a portion of the vertebra and adjacent intervertebral discs to allow for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, are used to stabilize the spine.
• Dynamic Stabilization: Following a disc removal, a stabilization implant is inserted with a 'dynamic' component. These devices offload pressure from the disc by rerouting pressure through the posterior part of the spinal column.
• Facetectomy: A procedure that removes a part of the facet to increase the space
• Foraminotomy: A procedure that increases the size of the nerve pathway
• Intervertebral disc annuloplasty (IDET): A procedure heats the disc to 90 °C for 15 minutes in an effort to seal it and perhaps deaden nerves irritated by the degeneration
• Artificial Disc Replacement (ADR), or Total Disc Replacement (TDR): This surgical procedure replaces the degenerated intervertebral discs in the spinal column with artificial ones.
• Laminoplasty: A procedure that reconstructs the spinal canal to make more room for the spinal cord.
• Laminotomy: A procedure that removes only a small portion of the lamina to relieve pressure on the nerve roots.
• Microdiscectomy: A minimally invasive surgical procedure during which a portion of a disk is removed.
• Percutaneous disc decompression: A minimally invasive procedure that reduces or eliminates a small portion of the bulging disc.
• Spinal decompression: A procedure that temporarily (a few hours) enlarges the intervertebral foramen (IVF) by aiding in the rehydration of the spinal discs.
• Spinal laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord.

Most doctors agree that preventing back pain or getting it under control – no matter the source – requires exercise to increase the strength and flexibility of muscles that surround and support the spine.

Exercise also increases blood flow to the back, which nourishes joints and muscles with oxygen and nutrients.

Along with following doctor’s instructions, getting the proper amount of physical activity, and strengthening the muscles that support the spine, you can manage your condition with the help of healthy lifestyle choices, such as:

• Eating a nutritious diet
• Stopping smoking
• Maintaining a proper weight

The positive and healthy choices we all make each day will help up live well and stay healthy.

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.