What is Degenerative Disc Disease?
Degenerative disc disease isn’t actually a disease. It is a condition in which a damaged disc causes pain. Degenerative disc disease (DDD) is the deterioration of the discs in the spine. Usually the condition causes no problems, but in some people, it limits range of motion and produces chronic pain.
As we age, the disc’s cellular composition changes and it becomes less able to absorb kinetic energy. Its gel-like nucleus loses water content, and collagen fibers in the outer ring weaken. The disc loses height and may bulge or herniate into the spinal canal, compressing nearby nerves and causing persistent back pain. Because branches of these nerves provide sensation to the arms and legs, pain from DDD can radiate down the leg or into the arm.
More women than men develop DDD. Smoking puts people at higher risk, as does work that requires strenuous physical labor, particularly on the night shift. On the other hand, lack of participation in athletic activity is also a risk factor. Among young people, being overweight or obese is strongly associated with both presence and severity of DDD.
What Causes Degenerative Disc Disease?
Doctors used to think that age and overuse simply wore out the discs. Although there is anecdotal evidence that long-term physical labor can contribute to DDD, researchers now believe that a genetic predisposition is the most important predictor of developing disc deterioration.
As a disc ages, it’s subjected to continual bio-mechanical stressors. It dries out, becoming flatter and less flexible. Small tears and other irregularities further compromise the disc’s structure, and it becomes less able to absorb shock than when it was intact and healthy.
Symptoms of Degenerative Disc Disease
For many people, Degenerative Disc Disease produces no symptoms. Those who do have symptoms most often report back pain. DDD pain is a type of radiculopathy. Those with cervical DDD may have pain in the arm, neck, or shoulder. Pain in those with lumbar DDD may extend into the buttocks, leg, or foot.
Degenerative Disc Disease can affect the cervical spine (neck), thoracic spine (midback), or lumbar spine (lower back); however, degenerative disc disease in the thoracic spine usually doesn’t generate symptoms, since the middle portion of the spine is more stationary than the neck and lower-back areas.
How Degenerative Disc Disease is Diagnosed
At Inspired Spine, an orthopedic surgeon will perform a thorough physical exam, assess your gait (walking ability), and ask for information including:
- Your general medical history, including your medications and any past surgeries.
- Describing your pain—for instance, is it sharp, stabbing, or aching?
- Does your back pain feel like an electric shock?
- When did your back pain begin and what brought the pain on?
- Is your back pain constant or intermittent?
- Which activities (such as walking) make it worse or better?
After determining that Degenerative Disc Disease may be the cause of your pain and discomfort, you may be sent for X-Rays to exclude other conditions associated with back pain, such as scoliosis, vertebral fracture, and spondylolisthesis.
If at least 6 weeks of conservative treatment is ineffective, he or she will probably also order an MRI scan of the spine.
When necessary, a spinal surgeon can perform a disc injection. Injecting a dye into the affected spinal disc allows the surgeon to visualize needle placement and gauge the health of the disc by assessing its size, shape, and anatomic integrity.
- If the patient continues to have no pain response when a higher volume of solution is injected, it means the disc has a low water content, an indication of disease.
- If injection of more solution reproduces the patient’s pain, it shows that the pain originates at the disc.
Degenerative Disc Disease Treatments
Treatment of DDD is dependent on the intensity of your back pain. At Inspired Spine, if you haven’t had prior treatment, and surgery isn’t needed, we begin with conservative treatments like physical therapy and nonopioid medications, progressing to prescription pain medication and other interventions as needed.
Physical therapy can strengthen the muscles that support the spine, relieving pressure on compromised discs, alleviating pain, and improving flexibility. Aquatic therapy is also a great way to relax the back, improve body mechanics, and tone back muscles. Modalities used to relieve the pain of DDD include massage, heat, ice, and electrical stimulation (see Transcutaneous Electrical Nerve Stimulation [TENS], below). Another option to improve posture and support the spine is bracing the back with a simple corset or a rigid plastic jacket.
Over the counter Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of defense in the medical treatment of DDD. Doctors also sometimes prescribe medications classified as anticonvulsants. These medications block certain nerve pain signals in patients with DDD. Muscle relaxants can be useful, too, and antidepressants, antianxiety agents, and sleep aids can address the depression, stress, and sleeplessness often associated with degenerative disc conditions.
When mild anti-inflammatory and pain relievers are not enough, opioids may be prescribed. When prescribed sparingly by doctors and used responsibly by patients, they can be an effective adjunct to a patient’s pain management plan.
To block transmission of pain signals and reduce inflammation in the spinal canal, your doctor can inject anesthetic medications or corticosteroids into the space surrounding the spinal cord (the epidural space).
The muscles surrounding the diseased disc or discs may be tender or tense. This tightness can be relieved by injecting anesthetics or corticosteroids at trigger points in affected muscles.
A small battery-powered unit can deliver a low-voltage electrical current to painful muscles in the back. This sensation may trick the brain into focusing on the harmless electrical stimulation generated by the TENS unit, rather than on pain signals arising from the same area.
Degenerative Disc Disease Surgery
If pain persists despite conservative degenerative disc disease treatment for 6 months or longer, it may be time to consider surgery.
Inspired Spine performs state-of-the-art minimally invasive spinal surgery with proven faster recovery times than traditional spinal surgery. Most of our spinal surgeries are outpatient and the patient is up and walking within 24 hours.