Degenerative Disc Disease
What is Degenerative Disc Disease?
Degenerative disc disease refers to a syndrome in which a compromised disc causes low back pain, or neck pain. Lumbar degenerative disc disease usually starts with a torsional (twisting) injury to the lower back, such as when a person rotates to put something on a shelf or swinging a golf club. However, the pain is also frequently caused by simple wear and tear on the spine. Despite its rather dramatic label, degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is deemed to be a normal finding, not the exception.
What is the cause of pain with Degenerative Disc Disease?
Generally, the pain associated with degenerative disc disease is thought to stem from two different factors:
- Abnormal micromotion instability
The proteins in the disc space can cause a lot of inflammation, and inflammation in the disc space can lead to low back pain radiating to the hips. The associated pain can also travel down the back of the legs.
If the annulus—the outer rings of the intervertebral disc - becomes damaged or worn down, it is not as effective in resisting motion in the spine. This condition has been termed “micromotion” instability because it is usually not associated with gross instability (such as a slipped vertebral body or spondylolisthesis).
Both the inflammation and micromotion instability can cause muscular spasm in the low back. The muscle spasm is the body’s attempt to stabilize the low back. It is a reflex, and although the body’s response of muscle spasm is not necessary for the safety of the nerve roots, it can be quite painful.
If the disc is degenerated in the cervical spine patient will have neck pain, and possibly pain radiating to the arms.
What are the common symptoms associated with Degenerative Disc Disease?
- The low back pain is generally made worse with sitting, since in the seated position the lumbosacral discs are loaded three times more than standing.
- Certain types of activity will usually worsen the low back pain, especially bending, lifting and twisting.
- Walking, and even running, may actually feel better than prolonged sitting or standing.
- Patients will generally feel better if they can change positions frequently, and lying down is usually the best position since this relieves stress on the disc space.
What treatments are available?
Many people in their thirties wonder if their degenerative condition will cause even more pain by the time they are in their sixties. But by the time you are 60, your discs may have dried out to the point that they cause less pain. While disc degeneration can’t be reversed, there is evidence that exercise and careful management of your back can contribute to better quality of life.
Nonsurgical treatment is the first step to recovery. If you don’t respond to this treatment, your doctor may recommend surgery; however, the long-term effectiveness of surgical treatment for degenerative disc disease as opposed to natural history, conservative treatment, or placebo has yet to be studied.
- Nonsurgical Treatments
- Nonsurgical treatment for degenerative disc disease may include medication, rest, physical therapy, home exercises, hydrotherapy, chiropractic, and pain management.
Using correct posture and keeping your spine in alignment are the most important things you can do for your back. You may need to make adjustments to your daily standing, sitting, and sleeping habits. You may also need to learn proper ways to lift and bend. Your work space may need to be rearranged to keep your spine from being under stress.
The goal of physical therapy is to help you return to full activity as soon as possible. Exercise is very helpful for the pain of degenerative disc disease, and it can help you heal faster. Physical therapists can instruct you on proper lifting and walking techniques, and they’ll work with you to strengthen and stretch your lower back, leg, and stomach muscles. They’ll also encourage you to increase the flexibility of your spine. Activity modification, rest, pain medication, muscle relaxants, and application of ice may be helpful in the acute stages. Although your physical therapist may show you strengthening exercises, it’s your responsibility to follow them.
Chiropractic manipulation, or spinal adjustment, is a primary treatment that chiropractors use for patients with back or neck pain. The chiropractor applies pressure to the area that is immobile or not moving properly. Some people have very good results after being treated by a chiropractor.
The philosophy behind chiropractic adjustment is to return the joints to more normal motion. Good joint motion is essential for the health and nutrition of the discs and joints because it permits the exchange of nutrients, fluids, and waste. Good motion helps reduce pain, muscle spasms or imbalance, and improves nervous system function and overall health. Without movement, discs and joints may degenerate more quickly than normal. Motion also reduces the formation of scar tissue, which can lead to stiffness and degeneration.
Your doctor may prescribe pain relievers, nonsteroidal anti-inflammatory medications (NSAIDs). Sometimes muscle relaxers are prescribed for muscle spasms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) - aspirin, naproxen (Naprosyn, Aleve), ibuprofen (Motrin, Nuprin, Advil), and celecoxib (Celebrex) are examples of nonsteroidal anti-inflammatory drugs used to reduce inflammation and relieve pain.
- Analgesics, such as acetaminophen (Tylenol) can relieve pain but don’t have the anti-inflammatory effects of NSAIDs. Long-term use of analgesics and NSAIDs may cause stomach ulcers as well as kidney and liver problems.
The most common spinal injection is the lumbar epidural steroid injection. This is particularly useful for pain that radiates from the lower back into a leg, and is caused by disc herniation or spinal stenosis (narrowing around the nerves) which triggers nerve root irritation. Similar injections can be very useful in the cervical spine, where the symptoms will extend into the arms. Thoracic epidural steroid injections are most commonly used to reduce the pain associated with herpes zoster (shingles). Such blocks may reduce the risk of developing persistent postherpetic neuralgia (i.e., pain which persists long after the skin eruption has healed).
The facet joints of the spine can also cause pain. Injections into the facet joints or blocks of the nerves that go to the facets can often be very helpful with these pains. This problem is more common in the lumbar spine, but also occurs in the neck.
Discograms (intradiscal injections of contrast under fluoroscopy or CT imaging) can determine if and which disc is the source of the pain. This can help a surgeon determine which levels of the spine require surgery. If the patient is found to have a painful disc, they may be a candidate for a new and promising technique, intradiscal electrothermoplasty (IDET). In a procedure similar to a discogram, a wire is temporarily inserted into the disc and used to heat the disc. This destroys the invading sensory nerves and causes the proteins of the disc wall to reshape and slowly strengthen (over 3-6 months). The procedure cannot be done if the disc has already severely degenerated.
Stem Cell Therapy
Stem Cell Therapy injections treat degenerative disc disease of the spine; degenerative joint disease of the hip or shoulder; arthritis; meniscus tears; rotator cuff injuries; Achilles tendon injuries; sacroiliac (SI) joint pain and more.
Surgery is rarely recommended unless you have a proven disc herniation or instability and your symptoms do not significantly improve with nonsurgical treatments. The goal of surgery is to stop the movement of the painful motion segment and decompress any spinal nerves. It is important to remember that while 80% of people will experience back pain during their lifetime, the pain tends to be brief and resolves with little or no medical treatment. You should understand what surgery can and can’t do, and whether it can relieve your particular symptoms. Talk to your doctor about whether surgery is right for you.