Your spine is a robust and resilient structure made up of vertebral bones
alternating with fibrous discs that continually absorb shock as you move.
This shock, which is just a transfer of energy, is usually minimal. For
instance, as a postal carrier walks their route, the spine absorbs kinetic
energy with each step. But the spine can handle more intense forces when
necessary, such as when a baggage handler lifts heavy pieces of luggage
and heaves them into the belly of an aircraft.
Degenerative disc disease (DDD) is the deterioration of the discs in the
spine. Usually the condition causes no problems, but in some people, it
limits range of motion and produces chronic pain.
Each intervertebral disc (“inter” means “between,”
and “vertebral” refers to the vertebrae) is composed of a
gelatinous central core, called the nucleus pulposus, surrounded by a
tough, fibrous outer ring, called the annulus fibrosis.
Figure 2: Each disc has a pulpy core surrounded by a tough outer ring.
As we age, the disc’s cellular composition changes and it becomes
less able to absorb kinetic energy. Its gel-like nucleus loses water content,
and collagen fibers in the outer ring weaken. The disc loses height and
may bulge or
herniate into the spinal canal, compressing nearby nerves and causing persistent
back pain. Because branches of these nerves provide sensation to the arms
and legs, pain from DDD can radiate down the leg or into the arm.
How Common is Lower-Back Pain Associated with Degenerative Disc Disease?
A recent study of almost 1,000 participants indicates that of those over
age 50, 71% of men and 77% of women have DDD. It affects 90% of those
age 65 and older.
More women than men develop DDD. Smoking puts people at higher risk, as
does work that requires strenuous physical labor, particularly on the
night shift. On the other hand, lack of participation in athletic activity
is also a risk factor. Among young people, being overweight or obese is
strongly associated with both presence and severity of DDD. However, most
people with DDD have no symptoms.
What Causes Degenerative Disc Disease?
The precise cause of disc degeneration in any given person is usually unknown.
Doctors used to think that age and overuse simply wore out the discs.
However, many people with strenuous physical jobs develop back pain, which
provides plenty of anecdotal evidence that “wear and tear”
do play some role in DDD. But researchers now believe that a genetic predisposition
is the most important predictor of developing disc deterioration.
As discs age, they’re subjected to continual biomechanical stressors.
It dries out, becoming flatter and less flexible. Small tears and other
irregularities further compromise the disc’s structure, and it becomes
less able to absorb shock than when it was intact and healthy. With less
support from the disc, nearby
facet joints and vertebrae must pick up the slack. A damaged disc may also protrude into the
spinal canal, crowding the space and impinging on nearby nerves.
What Are the Symptoms of Degenerative Disc Disease?
DDD can affect the cervical spine (neck), thoracic spine (midback), or
lumbar spine (lower back); however, thoracic disc disease usually doesn’t
generate symptoms, since the middle portion of the spine is more stationary
than the neck and lower-back areas.
For many people, DDD produces no symptoms. Those who do have symptoms most
often report back pain. DDD pain is a type of
radiculopathy. Those with cervical DDD may have pain in the arm, neck, or shoulder.
Pain in those with lumbar DDD may extend into the buttocks, leg, or foot.
How Is Degenerative Disc Disease Diagnosed?
Your doctor will ask about your general medical history, including your
medications and any past surgeries. He or she will ask you to characterize
your pain, for instance, is it sharp, stabbing, or aching? Does it feel
like an electric shock? The physician will want to know when the pain
began, what (if anything) brought it on, whether it’s constant or
intermittent, and which activities (such as walking) make it worse or
better. The doctor will perform a thorough physical examination and may
want to assess your gait (walking ability).
If at least 6 weeks of conservative treatment is ineffective, they will
probably also order a magnetic resonance imaging (MRI) scan of the spine.
Disc Injection
To diagnose disc degeneration, a surgeon can inject a contrast dye into
the body of the disc. The dye allows them to visualize needle placement
and gauge the health of the disc by assessing its size, shape, and anatomic
integrity. About 0.5 to 2.5 mL of solution can be injected into a healthy
disc without causing pain. If the patient continues to have no pain response
when a higher volume of solution is injected, it means the disc has a
low water content, an indication of disease.7 If injection of more solution
reproduces the patient’s pain, it shows that the pain originates
at that level.
How is Degenerative Disc Disease Treated?
Treatment of DDD begins with conservative treatments like physical therapy
and nonopioid medications, progressing to prescription pain medication,
and other interventions as needed.
Physical Therapy
Physical therapy can strengthen the muscles that support the spine, relieving
pressure on compromised discs, alleviating pain, and improving flexibility.
Aquatic therapy is also a great way to relax the back, improve body mechanics,
and tone back muscles. Modalities used to relieve the pain of DDD include
massage, heat, ice, and electrical stimulation. Another option to improve
posture and support the spine is bracing the back with a simple corset
or a rigid plastic jacket.
Medications
Nonopioid Agents: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (Aleve)
and ibuprofen (Advil) are the first line of defense in the medical treatment
of DDD. Doctors also sometimes prescribe medications classified as anticonvulsants.
These medications, such as gabapentin (Neurontin) block specific nerve
pain signals in patients with DDD. Muscle relaxants can be useful, too,
and antidepressants, antianxiety agents, and sleep aids can address the
depression, stress, and sleeplessness often associated with degenerative
disc conditions.
Opioids: These narcotic medications are prescribed to relieve moderate to severe
chronic pain. When prescribed sparingly by doctors and used responsibly
by patients, they can be a useful adjunct to a patient’s pain management
plan. If non-narcotic medications and other conservative treatments haven’t
worked for you, you and your doctor can discuss the risks and benefits
of opioid therapy. In some patients, these medications can be administered
utilizing an implantable drug pump that automatically regulates dosage
and administration.
Injections
Epidural injection of anesthetic or corticosteroid medications: To block transmission of pain signals and reduce inflammation in the spinal
canal, your doctor can inject anesthetic medications or corticosteroids
into the space surrounding the spinal cord (the epidural space).
Trigger point injections: The muscles surrounding the diseased disc or discs may be tender or tense.
This tightness can be relieved by injecting anesthetics or corticosteroids
at trigger points in affected muscles.
A small battery-powered unit can deliver a low-voltage electrical current
to the painful muscles in the back. This sensation may trick the brain
into focusing on the harmless electrical stimulation generated by the
TENS unit, rather than on pain signals arising from the same area.
When Should Surgery Be Considered for Degenerative Disc Disease?
If pain persists despite 6 months or longer of conservative treatment,
it may be time to consider surgery. All surgery involves risk, so discuss
your options carefully with your doctor. Weigh the benefits and risks,
such as damage to surrounding structures (which can be caused by open
surgery techniques, see “Minimally Invasive Spine Surgery Facts”), bleeding, leakage of cerebrospinal fluid, infection, and poor healing.
Fortunately, serious complications are rare, and most patients have favorable
outcomes with
minimally invasive spinal surgery. Only about 6% of patients require revision surgery within 7 years, and
recent advances in medicine and technology have given DDD patients and
their doctors even more options for decompression (surgical treatment).9
These advances include improved imaging quality, miniaturized surgical
instrumentation, high-definition video, and innovative surgical techniques.
Cervical Disc Degeneration
Cervical decompression is often accomplished by removing a diseased disc,
replacing it with an artificial one, and then fusing the spine with titanium
hardware that remains permanently in place. This procedure is most often
done by making an incision in the neck and retracting the trachea (moving
it to the side) to reach the cervical disc space in question.
Many other surgical options are available, too, depending on what form
of disc degeneration you have and where it’s located. For example,
in some cases, a laser can be used to cut out, aspirate (suck out), or
destroy the core of a disc, which decreases pressure on the outer ring
and adjacent nerve roots.
Lumbar Disc Degeneration
Disc replacement in the lumbar spine relieves pain, maintains the joint
space, and increases the strength and stability of the spine. Doing so
used to require complicated, expensive, risky open surgery. Fortunately,
newer procedures have made open surgery unnecessary in many patients with
lumbar DDD at one or two vertebral levels. Minimally invasive surgical
techniques, such as the
Inspired Spine oblique lumbar lateral fusion (OLLIF), requires only a small incision. Blood loss during the procedure is minimal,
recovery is generally quick, and most patients enjoy excellent results.
Call Inspired Spine today at
(952) 225-5266 for more information on conditions we treat.
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