Spine Information
Degenerative Disc Disease
Table of Contents
The process of degeneration of the intervertebral discs causes many
problems in the spine. Everything you do during the day while being
upright tests the spine's ability to support your body weight. Minor
injuries to the disc may occur and not cause pain at the time of the
injury. These repeated daily stresses and minor injuries can add up
over time and begin to affect the discs in your spine. The disc
eventually begins to suffer from the wear and tear-it begins to
degenerate.
Learn about degenerative disc disease including
- what parts of the spine are affected
- what causes the condition
- what symptoms are present
- what treatment options are available
In order to understand your symptoms and treatment options, it helps
to begin with a basic understanding of your low back. This includes
becoming familiar with the various parts that make up the lumbar spine
and how these parts work together.
The main problem with degenerative disc disease lies within one or
more of the intervertebral discs. There is a disc between each vertebra
in the spine. Much of the mechanical stress of everyday movements is
transferred to the discs. The intervertebral discs are designed to
absorb pressure and keep the spine flexible by acting as cushions
during body movement-similar to shock absorbers.
Without the cushion effect of the discs, the vertebrae in your spine
would not be able to absorb stresses or provide the movement needed to
bend and twist.
shock absorbers. Without the cushion effect of the discs, the vertebrae
in your spine would not be able to absorb stresses or provide the
movement needed to bend and twist.
A healthy intervertebral disc has a great deal of water in the
nucleus pulposus (the center portion of the disc). The water content
gives the nucleus a spongy quality and allows it to absorb spinal
stress. Excessive pressure or injuries to the disc can cause the injury
to the annulus (the outer ring of tough ligament material) that holds
the vertebrae together. The annulus is generally the first portion of
the disc to be injured. Small tears show up in the ligament material of
the annulus. These tears heal by scar tissue, which is not as strong as
normal ligament tissue. The annulus becomes weaker over time as more
scar tissue forms. This can lead to damage of the nucleus pulposus. It
begins to lose its water content and dry up. View animation of
degeneration.
Loss of water content causes the discs to lose some of their ability
to act as cushions. This can lead to even more stress on the annulus
and still more tears as the cycle repeats itself. As the nucleus loses
its water content, it collapses.
Without the cushion effect of the discs, the vertebrae in your spine
would not be able to absorb stresses or provide the movement needed to
bend and twist.
collapses, allowing the two vertebrae above and below to move closer to
one another. This results in a narrowing of the disc space between the
two vertebrae. As this shift occurs, the facet joints (located at the
back of the spine) are forced to shift. Shifting changes the way the
facet joints work together and can cause problems as well.
Bone spurs, sometimes called osteophytes, may begin to form around
the disc space. These can also form around the facet joints. This is
thought to be due to the body's response to try to stop the excess
motion at the spinal segment. The bone spurs can become a problem if
they start to grow into the spinal canal and press into the spinal cord
and spinal nerves. This condition is called spinal stenosis.
The most common early symptom of degenerative disc disease is
usually pain in the back that spreads to the buttocks and upper thighs.
When doctors refer to degenerative disc disease, they are usually
referring to a combination of problems in the spine that "start" with
damage to the disc, but eventually begin to affect all parts of the
spine. Problems thought to arise from the degenerating disc itself
include discogenic pain, and bulging discs.
Discogenic Pain
Discogenic pain is a term back specialists use when referring to
pain caused by a damaged intervertebral disc. A degenerating disc may
cause mechanical (or structural) pain.
As the disc begins to degenerate, there is some evidence that the disc
itself becomes painful. Movements that place stress on the disc can
result in back pain that appears to come from the disc. This is similar
to any other body part that is injured, such as a broken bone or a cut
in the skin. When these types of injuries are held still there is no
pain, but if you move them they hurt.
Discogenic pain usually causes pain felt in the lower back. It may
also feel like the pain is coming from your buttock area and even down
into the upper thighs. The experience of feeling pain in an area away
from the real cause is common in many areas of the body, not just the
spine. For instance, a person with gallstones may feel pain in the
shoulder or a person experiencing a heart attack may feel pain in the
left arm. This is referred to as radiation of the pain. It is very
common for pain produced by spine problems to be felt in different
areas of the body-including the back.
Bulging Discs
Bulging discs are fairly common in both young adults and older
people. They are not cause for panic. Abnormalities, such as bulging or
protruding discs, are seen at high rates on MRIs in patients both with
and without back pain. Some discs most likely begin to bulge
as a part of both the aging process and the degeneration process of the
intervertebral disc. A bulging disc is not necessarily a sign that
anything serious is happening to your spine.
A bulging disc only becomes serious when it bulges enough to cause
narrowing of the spinal canal. If there are bone spurs present on the
facet joints behind the bulging disc, the combination may cause
narrowing of the spinal canal in that area. This is sometimes referred
to as segmental spinal stenosis. View animation of bulging disc.
Before your doctor can diagnose your condition and design a treatment plan,
a complete history and
physical exam
are necessary. There are so many possible causes of pain. It is
important to determine what is and is not at the root of the problem.
You may be asked to take a variety of diagnostic tests. The tests
are chosen based upon what your physician suspects is causing your
pain. The most common diagnostic tests used to diagnose degenerative
disc disease are ordinary X-rays and
MRI
scans. If your doctor suspects disc degeneration, X-rays can be used to
verify a decrease in the height of space between vertebrae, bone spurs,
facet hypertrophy (enlargement), and instability during flexion or
extension of limbs. An MRI can verify loss of water in a disc, facet
joint hypertrophy, stenosis, or a herniated disc.
Conservative Treatment
Treatment will depend on the seriousness of your condition. Some
problems need immediate attention-possibly even surgery. The vast
majority of back problems do not require surgery. Treatment for your
back may be as simple as reassuring you that it is not a serious
problem and doing nothing but watching and waiting. In most cases,
simple therapies, such as mild pain medications and rest are effective in relieving the immediate pain.
The overall goal of treatment is to
- make you comfortable as quickly as possible
- design a spine-care program to reduce further degeneration
- get you back to normal activity in a timely manner
The more you know about how your back works and what you can do to
prevent further injury, the more effective your program will be.
Specific Rest
Immediately after a back injury, rest is often all your back needs
to feel better. Rest is used to take the pressure off your spine and
the muscles around it. You should rest in a comfortable position on a
firm mattress. Placing a pillow under your knees can also help relieve
pain. Do not stay in bed for several days. Bed rest for more than two
or three days can weaken the back muscles, making the problem worse
instead of better. Even though you may still feel some pain, a gradual
return to normal activities is good for your muscles. In most cases of
sudden back pain, the sooner you start moving again, the sooner your
back pain will improve. If you are sent to see a physical therapist,
the first few days may be spent educating you on ways to take stress
off the back, while remaining as active as possible. Short periods of
rest combined with brief exercises designed to reduce your pain may be
suggested.
Physical Therapy and Exercise
Your doctor may have you work with a physical therapist. A
well-rounded rehabilitation program assists in calming pain and
inflammation, improving your mobility and strength, and helping you do
your daily activities with greater ease and ability.
Therapy visits are designed to help control symptoms, enabling you
to begin moving and exercising safely and easily. Regular exercise is
the most basic way to combat back problems. Consider it part of
long-term health management and risk reduction program. Exercises focus
on improving strength and coordination of the low back and abdominal
muscles. The emphasis of therapy is to help you learn to take care of
your back through safe exercise and self care when symptoms flare up.
Therapy sessions may be scheduled two to three times each week for up
to six weeks.
The goals of physical therapy are to help you
- learn ways to manage your condition and control symptoms
- maintain appropriate activity levels
- learn correct posture and body movements to reduce back strain
- maximize your flexibility and strength
ESI
An epidural steroid injection (ESI)
can be used to relieve the pain of stenosis and irritated nerve roots,
as well as to decrease inflammation. Injections can also help reduce
swelling from a bulging or herniated disc. The steroid injections are a
combination of cortisone (a powerful anti-inflammatory steroid) and a
local anesthetic that are given through the back into the epidural
space. ESIs are not always successful in relieving symptoms of
inflammation. They are used only when conservative treatments have
failed.
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