Overview of Degenerative Disc Disease Treatments

Degeneration of the intervertebral discs is called degenerative disc disease (DDD). With this condition, minor injuries and repeated daily stresses eventually wear down the spine and cause back pain. Degenerative disc disease can affect your ability to stand upright and perform daily activities.

What causes degenerative disc disease?

There is a quarter-sized, fibrous disc between each of the spinal bones, which are called vertebrae. The discs absorb pressure, cushion the spine, and promote spine flexibility. The discs have a watery, gel-like substance in the center, which is called the nucleus. The nucleus is surrounded by fibrous, tough outer layers, which are collectively called the annulus. With degenerative disc disease, the disc loses water content and develops tears and cracks in the annulus. This can cause the vertebrae to shift out of position, which can lead to pressure on the spinal nerves.

The water of the nucleus gives the disc a spongy quality, allowing it to absorb stress. Injuries and excessive pressure to the disc causes damage to the tough outer annulus. Tears heal with scar tissue, which weaken the disc. Eventually, the water loss causes the vertebrae above and below it to move closer together. As this occurs, the facet joints (tiny joints on the posterior of the spine) shift, which changes the way the spine moves. In addition, bone spurs can form around the facet joints, causing nerve compression and back pain.

What are the symptoms of degenerative disc disease?

The most common symptom of degenerative disc disease is discogenic pain. Most people have DDD in the lower back region (lumbar spine). The pain is often descried as a dull ache that radiates into the buttocks. In addition, pressure on spinal nerves and nerve irritation lead to nerve-related radicular pain. This causes leg pain, numbness, and weakness.

How does the doctor diagnose DDD?

The doctor will ask you questions about your symptoms, take a medical history, and perform a physical examination. The exam involves:

• Weakness – The muscles are tested for strength, and you are asked to push against light resistance or lift some items.

• Motion of neck and spine – The doctor will have you move through a series of range of motion tests.

• Sensory changes – The doctor determines if you can sense pain, temperature changes, and light touch.

• Pain and tenderness – The doctor will see if spine areas are tender or painful.

• Reflex changes – The tendon reflexes are tested (knee and ankle jerk).

• Motor skills – This involves heel-toe walking and other motor tests.

In addition, the doctor will order some diagnostic tests, including x-rays and magnetic resonance imaging (MRI) scans.

How is degenerative disc disease treated?

Treatment options include:

• Medications – Aspirin is used for minor pain and back ache. Nonsteroidal anti-inflammatory drugs (NSAIDs) help with inflammation in the facet joints. For severe pain, narcotic agents are used. Muscle relaxants help when the patient is having muscle spasms. In addition, nerve-related symptoms may be treated using certain anticonvulsants and antidepressants.

• Epidural steroid injection (ESI) – Usually given in a series of 3, ESI is used to relieve irritated nerve roots and pain associated with nerves. The doctor injects the epidural space using a steroid, with or without an anesthetic. Most clinical studies show this procedure is 90% effective.

• Physical therapy – To relieve pain, the therapist can use heat, ice, massage, electrical stimulation, and ultrasound. In addition, physical therapy involves posture training, flexibility exercises, and strength training.

• Surgery – cutting edge minimally invasive keyhole spine surgery is a good last resort option. The latest option includes the OLLIF procedure, which is short for oblique lateral lumbar interbody fusion. The procedure is shorter and involves less blood loss than traditional fusion procedures.

Resources

Lee JW, Kim SH, Choi JY, Yeom JS, Kim KJ, Chung SK, et al. (2006). Transforaminal epidural steroid injection for lumbosacral radiculopathy: preganglionic versus conventional approach. Korean J Radiol, 7:139–144.