Degenerative Disc Disease
What is DDD?
Degenerative disc disease (DDD) is a fairly common disease condition that affects the disc spaces within the spine. It is most commonly seen in the cervical (neck) and lumbar (lower back) regions.
Our spines are made up of a column of bones that are called vertebrae and in-between each pair of vertebrae is a gel-filled sac, the disc. That sac acts as a cushion with movement, preventing the vertebrae from rubbing together. The disc is commonly thought of as a jelly donut as there is a tough outer wall (annulus) and a soft center (nucleus). With DDD, the disc spaces dry out or “degenerate”, losing their ability to cushion your spine as efficiently. This leads to additional stress on other structures in the spine, such as the facet joints between the vertebrae, as well as supporting muscles and ligaments. In some people, this may result in pain.
What causes DDD and who is affected?
It is largely unknown what causes DDD, but we do know it becomes more prevalent as people age. However, it can affect younger adults and middle-aged people as well. Additionally, those with arthritis, osteoporosis, and back injuries are more prone to developing DDD. There is also likely a genetic component, as those with a family history of DDD are more likely to develop the condition. We also know that those who smoke and work in physically demanding occupations are at a greater risk for developing the condition.
Symptoms of DDD?
Symptoms of DDD vary widely from person to person. The pain may start with an unexpected injury or may start gradually and worsen with time. The pain may be chronic or may be associated with periodic “flare-ups.” The most common location of pain is in the lower back, though it may also radiate to the buttocks and legs. The pain tends to be worse with sitting, prolonged standing, and with bending or twisting of the back as this puts more weight on the discs. MRI usually reveals one or more degenerated discs, but not all people with this finding will have pain.
How can I treat my DDD?
There is no cure for DDD, but there is evidence that exercise and care of your back will lead to improved qualitiy of life. Surgery is rarely needed for this condition, unless there is evidence of instability in the spine (e.g. slipped vertebrae) or severe compression of the nerves. Nonsurgical treatments include medications, physcial therapy, chiropractic care, pain management, and alternative medicine treatments such as acupuncture. -Medications:
Commonly prescribed medications include pain relievers, NSAIDs (Non Steroidal Anti-Inflammatory Drugs), muscle relaxants and steroids.
• NSAIDs - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and celecoxib (Celebrex) are examples that help reduce inflammation and relieve pain.
• Analgesics- acetaminophen (Tylenol) or stronger narcotics as prescribed by your doctor to relieve pain.
• Steroids- Medrol dose pack helps to reduce swelling and inflammation of the nerves.
• Muscle Relaxants- cyclobenzipine (Flexeril), diazepam (Valium), and others.-Physical therapy:
The goal of physical therapy is to help improve your mobility and flexibility to promote fast healing. Physical therapists will help instruct you on proper body mechanics to reduce the chance of further injury and disability. There is also a focus on strengthening core muscles to take the pressure of the spine.-Chiropractic care:
The goal of chiropractic care is to return joints to a more normal motion as normal joint motion helps promote the exchange of fluids, nutrients, and waste. Spinal manipulation is commonly used for improvement of neck and back pain.-Pain Management:
A pain management specialist can perform a procedure called an epidural steroid injection (ESI) or facet joint injections where steroids are directly injected into a targeted area to help reduce swelling and relieve pain. -Alternative Medical Treatments:
The effectiveness of these treatments is largely unknown, but they may help
with managing pain and improving overall health.
• TENS (Transcutaneous Electrical Nerve Stimulation) unit
• Nutritional supplements
• Dry Needling