What is degenerative disc disease?
The condition known as degenerative disc disease means there is a structural abnormality within the disc itself. Picture a three legged table where the disc in the front represents one leg and the facet joints represent the other two rear legs. If wobbling or instability occur when there is evidence of this deterioration causing collapse, narrowing, or damage, many times the nerve roots become irritated from inflammation or direct contact. This typically occurs in both the neck and low back but seems to be more common in the low back. The process of the disc thinning, bulging, or rupturing is due to deterioration of the proteoglycans within the desk. According to web M.D., cervical degenerative disc disease (DDD) affects approximately 25% of people without symptoms under age 40. 60% of people over age 40 have symptoms. This is more of a condition than a disease however it can contribute to various other diseases. The collagen which makes up the disks become less flexible and less elastic throughout the body. The process of disc desiccation is where the disc starts to dry out and become less flexible. The loss of disk elasticity occurs throughout the body as well. The spinal discs in the low back are particularly prone to these problems, potentially due the increased stress of weight bearing. A typical course of treatment includes physical therapy, medication, artificial disc replacement or cervical fusion surgery. In the low back, degenerative disc disease often causes unremitting low back pain particularly with Weight-bearing activities. Degenerative disc disease can lead to serious conditions such as spinal stenosis, osteoarthritis of the joints as well as spondylolisthesis or misalignment of the spinal vertebrae.
What are the symptoms of degenerative disc disease?
The primary symptoms of lumbar disc degeneration include back pain and intermittent leg pain. The pain in the leg can be associated with numbness, tingling, or weakness. The back pain tends to be worse when someone is upright with relief experienced when someone is lying down. There are two possible reasons for the pain associated with degenerative disc disease the first is abnormal micro motion and the second is inflammation. Abnormal micro motion takes place when the material covering the outside the disks begins to deteriorate. The normal shocks experienced within the disc spaces lead to progressive micro motion or instability. When someone has instability the obvious treatment is to stabilize that segment. Recently stem cells harvested from the pelvis have been very effective in treating motion associated with wear and tear of the annulus. In cases where pain persists despite treatment with stem cells, there may be a role for spinal fusion.
Spinal disks are mostly protein. There is a internal collagen matrix and an external covering call the annulus. When the annulus tears, it can cause significant discomfort which seems to be self-limiting and is often treated with steroids and bedrest. The pain typically disappears after approximately one week, occasionally the annular tear may be seen on MRI. When the disc degeneration is progressive and severe, the pain becomes worse and often spreads from the back into the buttocks and legs. If the inflammation strikes the nerves, pain may radiate to the upper back and cause profound muscular spasm. Many times the muscles will try to compensate and stabilize the disc by developing protective muscular spasm. These spasms can be quite painful as well.
Many times patients will experience low back pain that is related to degenerative disc disease. MRI scan imaging is very helpful as well as plain x-rays looking for disc collapse and misalignment. If a single disc appears to be problematic, many times the surgeon can focus on that area however in cases where the disks are showing multiple areas of degeneration a test called lumbar discography is often helpful. By placing a small amount of dye into the disc space under local anesthesia many times there can be obvious pain provocation which identifies the symptomatic disc
If you think you have degenerative lumbar disc disease or have any family history of this disorder in other family members, you should be seen. Normally things like physical therapy and anti-inflammatories are effective however in certain cases and MRI scan and even surgery are affective possibilities.