Degenerative Disc Disease
Degenerative Disc Disease is a naturally occurring process in which the spine ages, much like our skin will age and get wrinkles and we will lose hair as we get older, that is men do. Degenerative Disc Disease is something that normally will be seen as we age. It is truly not a disease itself, but rather a condition, that may or may not be symptomatic. Much of this has to do with the genetics of the patient, their lifestyle and any injuries that they may have had along the way.
Symptoms: The symptoms of Degenerative Disc Disease could be none, or they may be precipitated by some type of incident, or in many cases the patients have no idea why they became symptomatic except waking up one day. In general, patients will complain primarily of just low back pain and occasionally if the degeneration progresses, nerves may be pinched, giving the patient back and leg pain which sometimes, if severe, causes pinching of the nerves, giving them what we call sciatica.
The usual symptoms of Degenerative Disc Disease that are symptomatic are just to have intermittent back pain. It may be of increasing frequency and that is why it is recommended that people seek professional evaluation to determine whether or not therapy anti-inflammatory medications and perhaps even injections may be helpful.
Testing and diagnostics: Generally plain x-rays can show whether or not there is evidence of Degenerative Disc Disease. This may be seen by narrowing as well as slight bone spurs. If it is severe and your doctor feels that you are not progressing with the usual conservative treatment of short-term rest, exercise therapy and anti-inflammatories an MRI scan can be ordered. This is a non-invasive study. In very rare cases where patients are not responding to conservative treatment and have failed all measures, including even injections, there is a study that is called a discogram, in which we actually place a small needle, under sedation, into the disc to try and create the patient’s pain.
The most common treatment option is conservative treatment, consisting of physical therapy, learning the proper core exercises and doing therapeutic or pain relieving exercises. Anti-inflammatories are also helpful and over the counter Naproxen or Ibuprofen are the most common anti-inflammatories used today. The patient should soon responds depending on whether or not they are having just low back pain or back and leg pain. They may be a candidate for cortisone injections. These may consist of putting a small needle into the little connecting joints called the facet joints that occur in the back part of the spine, or placing a small needle into the spinal canal in and around the nerves to alleviate the pain. These injections consist of numbing medicine, as well as steroid medications. When one progresses beyond the conservative treatment, or has failure of conservative treatment, then operative intervention may be considered. For Degenerative Disc, if there is no nerve compression, often times a fusion would be carried out. Fusion means making the two bones on the two sides of the disc grow together so there is no motion and no stimulation of the little nerves that surround the outer portion of the disc that is the soft nucleus in between the vertebral bodies. Now we have a newer treatment option which is disc replacement, which is discussed in greater detail in another section. This involves placing an artificial disc which is made up of materials very similar to artificial hips and knees. Some of the newer disc replacements also have the ability to have shock absorption much like our normal disc.
In most cases it is just the normal aging process. It can certainly be affected by genetics and if your mother and father have problems with their back it is not unusual that you too will have problems with your back.
No, it really isn’t a disease in the typical sense, meaning that there is not a pill you can take to stop it, and it is not life-threatening. It is more of a wear and tear process.
No, most patients usually will respond to an active exercise program, strengthening their core or trunk muscles, learning proper body posture and body mechanics, losing weight if they are overweight and the use of anti-inflammatories in the vast majority of cases.
We know that 90% of individuals will experience 1 episode of low back pain and about a third of this 90% will have chronic intermittent back pain. If one exercises and takes care of their spine, the pain-free intervals can actually be quite long and recovery from these episodes will be relatively shortened. That’s why it is very important to practice good body posture and body mechanics and to do your exercises.
No one can guarantee complete relief of pain, even with surgery; however, we know the vast majority, 80-90 percent of patients, will achieve at least a 50% reduction of their pain, and in many cases they will be even better. This is with respect to a fusion and the artificial disc.
Hopefully not. If you are reading this, means that you are interested in intervening before your symptoms become worse. Most patients will respond to non-operative treatment that was discussed above, and in very rare cases, surgery may be needed.
Unfortunately, we know that genetics does play a role in the conditions that our family gets. While there has been research to determine what genes may be associated with Degenerative Disease, it is not clear-cut at the present time. The most important thing is for all patients to be physically fit, of normal weight, and to practice good body posture and body mechanics.