
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.
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.
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.
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.
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.
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.
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).
Your doctor may send you for x-rays to exclude other conditions associated with back pain, such as scoliosis, vertebral fracture, and spondylolisthesis.
If at least 6 weeks of conservative treatment is ineffective, they will probably also order a magnetic resonance imaging (MRI) scan of the spine.
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.
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 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.
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.
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 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.
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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