Degenerative Disc Disease

Degenerative Disc Disease

Degenerative disc disease is a condition that occurs when the spinal discs wear down.

Spinal discs are rubbery cushions between the vertebrae.  They act as shock absorbers and help with movement bending and twisting.  Discs degenerate over time and this is a natural part of aging.   When cushions wear away, the bones can start to rub together and cause other problems like:

• Adult scoliosis where the spine curves
• Herniated disc bulged, slipped or ruptured disc
• Spinal stenosis - when the space in the spinal canal narrows
• Spondylolisthesis - when vertebrae move in and out of place

Disc degeneration mostly affects the lower back (lumbar spine or neck (cervical spine).

Lumbar degenerative disk disease affects the lumbar spine or the five vertebrae (L1 to L5) in the lower back.  The spinal discs separate each of the vertebrae.   It has been estimated that 90% pf degenerative disc disease occurs in the lowest portion of the lumbar spine. 

Cervical degenerative disk disease occurs in the seven vertebrae of the neck (cervical spine.  These vertebrae are separated by a spinal disc.   Cervical degenerative disc disease is a condition where the discs in the neck lose hydration and elasticity over time, leading to pain and stiffness.  The cervical spine is responsible for movements such as turning the head from side to side or moving the head up and down. 

Multilevel degenerative disk disease is diagnosed when degenerative disk disease affects more than one disk or level of the spine.  Both areas of your lumbar and cervical spine can be affected. 

Causes

Degenerative Disc Disease is a common part of aging and can cause symptoms like neck pain, radiating arm pain, and numbness.  Almost everyone has some disk degeneration after age 40.  It can lead to back pain in about 5% of adults.  The condition doesn’t always cause symptoms.  When it does back and neck pain can be intense. 

Symptoms

• Neck and back pain can be mild, moderate or severe
• Pain can be sharp, moderate or severe and may start and stop
• Radiates down back and buttocks
• Worsens with sitting, bending or lifting

Diagnosis

Four stages can be used to diagnose Degenerative Disc Disease

• The spinal discs have started to degenerate and the patient experiences mild degenerative disc disease
• The spinal discs have started to dry out, causing them to lose some height and flexibility.  Neck and back pain may worsen at this stage
• Neck and back pain may worsen at this stage
• Spinal disks continue shrinking and the bones in the spine rub together.  The damaged discs press against the nerves, causing severe pain. 

Degenerative disc disease can be diagnosed by physical exam that includes questions such as

• When did pain start and where is it located?
• What activities increase or decrease the pain?
• Did an injury or accident initiate the pain?
• The presence of other symptoms like tingling and numbness
• The physical exam will help determine nerve function, pain levels and strength.
• Tests may also be used to diagnose Degenerative Disc Disease to identify he state and alignment of discs.
• Xray
• Ct scan - Cat Scan
• MRI - Magnetic Resonance Imaging

Treatment

Usually, non-invasive degenerative disc treatment options are recommended first and may include

• Physical Therapy - strengthening and stretching exercises with a licensed physical therapist
• Medications: Taking Nonsteroidal anti-inflammatory drugs, acetaminophen, neuromodulation medication or steroids.
• Steroid injections - injecting medicine near the affected spinal nerves, discs or joints to reduce inflammation and pain

Surgery

Surgery may be an option if a patient has persistent pain and or weakness.  There are several types of spinal decompression surgery including

• Diskectomy - Removing part of a spinal disk to relieve pressure on the nerves
• Foraminotomy - Expanding the opening of the nerve roots by removing tissue and bone
• Laminectomy - Taking out a small portion of bone from the lamina (lower spine)
• Osteophyte removal - Removing bone spurs (osteophytes
• Spinal fusion: - connecting two or more vertebrae to improve stability.

Most people who have surgery for degenerative disk disease experience long-term pain relief.  After surgery it is necessary to continue exercising and stretching to keep the back strong and healthy. 

Prevention and self-care

The progression of spinal degeneration can be prevented or slowed by lifestyle changes that include:

• Achieving and maintaining a healthy weight
• Avoiding or quitting smoking
• Physical activity to increase strength and flexibility as recommended by a physical therapist or physician.

Alcohol, smoking, lifting heavy objects, high impact physical activity and long periods of seating increase the risk of back pain and should be avoided.