Degenerative Disc Disease
Degenerative Disc Disease occurs during the normal aging process, and is often referred to as “arthritis of the back.” Degenerative Disc Disease is a progressive deterioration of the structures of the spine. With age, the discs located between the vertebral bodies lose their elasticity and may cause one vertebral body to collapse down onto another. Osteophytes, or overgrowth of bone, may form on the edges of the vertebral bodies bordering the degenerative disc. The vertebrae are connected by two small joints or “facet” joints which can enlarge. In addition, ligaments that stabilize the vertebral column may thicken. The above abnormalities may produce spinal stenosis, or narrowing of an area in the spinal canal. The narrowing may compress nerve roots or the spinal cord, causing back or leg pain.
Some wear and tear of the spine’s intervertebral discs is normal. However, there are multiple causes of degenerative disc disease. For example, genetics – some families have more disc degeneration; obesity – too much weight places extra stress on the spine and the shock absorbing discs; lack of exercise – can result in a weak trunk and abdominal muscles that do not support your spine during movement; work activities – sitting for long periods of time, lifting or pulling heavy objects, bending, twisting or repetitive movements and exposure to constant vibration can harm the spine; smoking – tobacco use can deprive the spine of blood flow and nutrients needed to repair disc tissue, injuries – prior injuries, disc herniation, or back surgeries can put you at increased risk for degenerative disc disease.
What are the Symptoms of Degenerative Disc Disease?
Degenerative discs do not always result in pain. When pain occurs, it is often from weakened discs and other spinal structures becoming irritated and painful with movement. You may have pain after physical activity or after sitting for long periods. Your pain may be sharp, throbbing or burning and may extend down into one or both legs. Your back may also feel stiff and you may experience numbness, tingling, or weakness in your legs, feet, or buttocks.
How is Degenerative Disc Disease Diagnosed?
In addition to your symptoms, degenerative disc disease can be diagnosed on physical exam by your treating Primary Care Physician or Neurosurgeon. Your physician may have you obtain diagnostic imaging to aid in confirming the diagnosis. For example, X-ray studies may be ordered that may reveal evidence of narrowed discs and/or thickened facet joints. A Magnetic Resonance Imaging (MRI) scan may be obtained for more detailed evaluation of spinal structures. These studies can provide information about the presence, location, and extent of spinal canal narrowing and nerve root pressure. Also, a Computed Tomography (CT) scan may give clearer information about bony invasion into the spinal canal.
How is Degenerative Disc Disease Treated?
Depending on the severity of your symptoms, a course of non-surgical treatment may be prescribed by your primary care physician or neurosurgeon. This typically involves a combination of medications, physical therapy, and epidural steroid injections.
Medications that are typically prescribed include pain medications to help with your symptoms as well as anti-inflammatory medications, such as ibuprofen, to help decrease inflammation around the nerves in your spine. Occasionally other medications such as Lyrica and Neurontin are prescribed to help with nerve pain.
In addition to medications, a physical therapy program may be incorporated as a form of non-surgical treatment. A physical therapy program usually begins with stretching exercises to restore flexibility to tight muscles in the neck, trunk, arms, and legs. Depending on your response to physical therapy, stretching exercises may progress to cardiovascular exercise and strengthening exercises for your arms, legs, and trunk muscles.
Epidural steroid injections may also be prescribed and involve injection of corticosteroids into the area around your spinal cord and nerves in order to reduce inflammation.
If you fail to respond to non-surgical treatment, surgery may be recommended. Surgery can relieve the pressure on spinal nerves and reduce your pain and other symptoms. For example, a laminectomy removes all or part of the “roof” or lamina on the spinal canal to relieve pressure on the nerves. It is very successful in relieving leg pain and numbness. A discectomy removes all or part of the disc to relieve pressure on the nerves. A spinal fusion joins two or more vertebrae to stop motion at a painful area. It is used for multiple herniated discs or for an unstable spine. Bone grafts are inserted between the bones to encourage the body’s ability to grow new bone and fuse the bones together. Other devices such as small screws, plates, rods, an interbody spacer, or a cage can help stabilize your spine while the bones are fusing and your body is healing.