Degenerative Disc Disease
Whoever said that aging was not for the faint of heart may have been thinking about degenerative disc disease. One of the most common spinal ailments that occurs due to age, degenerative disc disease can have a debilitating effect on your everyday life. This is what you should know about causes and treatments.
What is degenerative disc disease?
Our spinal column is made up of 33 vertebrae that are connected at the facet joints with tendons and ligaments. Separating these vertebrae are intervertebral discs. These discs have a jelly-like interior that cushion and ease each vertebrae’s movement.
Degenerative disc disease refers to the degeneration, or normal wear and tear, of these intervertebral discs. Over time they can become worn and thin, allowing the bones to rub painfully against one another. The intervertebral disc itself becomes the source of pain. The wear that occurs in the disc leads to an inability to effectively distribute pressure through the spinal column.
It’s a natural process that typically affects all individuals and progresses with age. In fact, degenerative disc disease is one of the most common causes of lower back and neck pain.
What are the major causes of degenerative disc disease?
Age is the major cause of degenerative disc disease, but the development of symptoms is variable. Some people experience significant pain while others will experience none.
For those who do experience pain, the progression of pain has been referred to as a degenerative cascade process. This process generally is as follows:
- Acute injury occurs to the disc
- The injury causes instability of the spine and inflammation, with intermittent bouts of pain
- With healing, the instability corrects itself and fewer episodes of pain occur
Pain begins with some sort of acute injury that causes inflammation and disc compression. This leads to instability of the spine and a potential reflexive muscle spasm. Pain may come and go, with periods of severe pain and times with no pain at all. Generally, as the instability resolves through treatment (see below), pain improves. However, if the pain continues or becomes more severe, it is important to look for other potential conditions.
Other than pain, symptoms associated with degenerative disc disease include the following:
- Numbness in the extremities
- Tingling
- Radiating pain
If these symptoms get worse, or weakness develops, it is possible that the degenerative disc disease has progressed into a disc herniation, compressing and possibly damaging nearby nerve roots.
Diagnosis is only made by excluding other possible causes. Your doctor will take a complete medical history and perform a physical exam.
Imaging studies such as magnetic resonance imaging (MRI) may be conducted, but it is important to note that an MRI cannot diagnose degenerative disc disease alone. For example, some people experience extreme pain with no radiologic findings while others may have evidence of disc degeneration yet experience no symptoms.
An MRI must be used in conjunction with other diagnostic criteria and exclusion of other potential causes of pain.
For symptoms that do not improve with conservative or minimally-invasive therapy within six months, the definitive treatment for moderate or severe carpal tunnel syndrome is surgical decompression of the median nerve. Surgical intervention is generally more effective than conservative treatments, especially for moderate to severe cases.
Carpal tunnel surgery can be performed via open incision or endoscopically. An open release is performed via standard incision under local anesthesia. This gives your doctor the best view but is slower to heal.
An endoscopic release is performed with scopes and surgical tools through one or two small openings and can result in less scar tissue and post-operative pain.
The prognosis for carpal tunnel syndrome surgery is good, although a minority of patients, particularly those with advanced carpal tunnel syndrome, may fail to improve after the procedure.
Additionally, scarring post-surgery can lead to a recurrence of symptoms several months or years later. The most effective carpal tunnel treatment is to prevent it altogether by taking steps to protect your wrists and hands from repetitive motion injury.
5 degenerative disc disease treatments
This condition is best treated in the most conservative manner possible. Here are five potential treatments, many of which occur simultaneously for best results.
Heat and ice can be used at the site of pain to relieve inflammation. Alternate treatments or ask your doctor which might be most effective for you.
Do note that rest is only recommended during the acute phases of injury.
Core strengthening and aerobic conditioning help improve overall physical fitness. Core strength in particular can help to better support your spine and take the pressure off of discs.
Medications such as acetaminophen or ibuprofen can manage mild chronic pain on an acute basis. Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen can also help reduce inflammation.
It is important to note that opioids are no longer recommended for long-term management of chronic pain.
Physical therapy that includes therapeutic exercise, gentle stretching, electrical stimulation, traction, and more can be beneficial.
A physical therapist can help you to correctly move through these exercises to relieve pain and strengthen your body.
Surgical options are utilized only when the most conservative measures have failed. There are multiple surgical options:
- Spinal fusion of the vertebrae around an affected disc restricts joint motion to ease pain
- Dynamic stabilization is similar to fusion but uses more flexible materials as an internal brace to allow for more movement
- Disc arthroplasty, or artificial disc replacement, essentially installs a brand-new disc
- In some cases, nucleoplasty (removal of disc material) restores function and relieve pain
Remember that surgery is not a guaranteed fix. Not everyone finds relief through surgery, and post-operative pain and stiffness may prevent a full return to pre-operative activity levels.
References
- Ullrich, P.F. (2005) What is degenerative disc disease? Spine-Health. Retrieved from www.spine-health.com/conditions/degenerative-disc-disease.
- Williams, K.D.; Park, A.L. (2007). Degenerative Disc Disease and Internal Disc Derangement. Campbell’s Operative Orthopaedics, 11th Ed. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu/books
- Isaac, Z.; Anderson, B.C. (2011). Evaluation of the patient with neck pain and cervical spine disorders. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Anderson, B.; Isaac, Z.; Devine, J. (2010). Treatment of neck pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.