Degenerative Disc Disease

Degenerative Disc Disease

Degenerative disc disease (DDD) is a condition that results in intervertebral disc deterioration. As a disc deteriorates, it presses on the spinal nerves, which causes radiating pain down a leg or arm.

 

What are intervertebral discs?

 

Intervertebral discs lie between the vertebrae, which are the spinal bones. These cushioning discs are quarter-sized, and the center (nucleus pulposus) is filled with a watery, gel-like substance. The center portion should contain around 80% water, but with DDD, the water content decreases.  

 

How many people are affected by low back pain and DDD?

 

In America, low back pain is a common musculoskeletal problem, and it is the third most frequently reported symptom. Around 20% of all physician visits are related to back pain. In a recent study involving almost 1,000 participants, researchers found that the prevalence of DDD in men under 50 was 71%, and for women, it was 77% in that age group. For men and women over the age of 5 years, DDD affects 90% of people.

 

What causes degenerative disc disease?

 

When discs lose water content, they become less flexible and shorter. Once discs are injured, the spine cannot tolerate stress, which often leads to other problems. Normally, discs act as a cushion between the vertebrae, but with DDD, the vertebra bony prominences and bone spurs press on nerves and cause pain. DDD also is common along with spondylolisthesis, where bone spurs and vertebral alignment cause narrowing of the spinal cord and nerve compression.

 

What are the symptoms of DDD?

 

For many people, degenerative disc disease does not cause any symptoms. However, the most common symptom associated with DDD is pain, which can gradually increase over time. The pain often radiates (shoots) down an arm or leg, which depends on the location of the DDD. Other symptoms include arm/leg numbness, tingling, and weakness, as well as difficulty sleeping.

 

How is degenerative disc disease diagnosed?

 

The doctor can diagnose degenerative disc disease by performing a physical examination and with diagnostic imaging tests. X-rays are used to show bone deterioration, and a magnetic resonance imaging (MRI) scan will show damage to the discs and soft tissues.

 

How is degenerative disc disease treated?

 

Treatment of degenerative disc disease includes:

 

  • Physical therapy – The therapist can use strengthening exercises to alleviate pain and improve flexibility. In addition, aquatic therapy is used to relax the back and learn proper body mechanics. Modalities used to relieve pain include massage, heat, ice, and electrical stimulation. Bracing involves a simple corset or rigid plastic jacket that improves posture.

 

  • Medications – Many medications are used to treat the pain and nerve symptoms associated with DDD. These include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, antidepressants, and anticonvulsants.

 

  • Epidural injections – The injection is done by inserting a needle into the epidural space (around the thecal sac) and then injecting a steroid medication. This will reduce inflammation in the spinal canal.

 

  • Trigger point injections – A small needle is used to injection the muscles with lidocaine. This is used to relieve tenderness, tension, and stress.

 

  • Transcutaneous electrical stimulation (TENS) – A small unit is used to provide electrical stimulation to painful areas of the back. The device uses low current electrical charge to block transmission of pain signals.

 

Resources

 

Bressler HB, Keyes WJ, Rochon PA, et al. (1999). The prevalence of low back pain in the elderly: a systematic review of the literature. Spine, 24:1813–9.

Brodke DS & Ritter SM (2005). Nonsurgical management of low back pain and lumbar disk degeneration. Instr Course Lect, 54:279–86.

Teraguchi M, Yoshimura N, Hashizume H, et al. (2014). Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study. Osteoarthritis and Cartilage, 22(1) 104-110.

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