There is promising news for millions of patients who suffer from lower back pain and disability caused by degenerative disc disease. Researchers in Hong Kong recently published their findings in the medical journal Spine. They found a novel imaging biomarker that seems to correlate to degenerative disc disease and lower back pain.
While the researchers noted that much more investigation is necessary before this imaging protocol is used for diagnosing this painful condition, it has the potential of allowing spine surgeons to gain more insights without being forced to use more invasive testing.
As a spine surgeon at Texas Back Institute, Dr. Jessica Shellock has diagnosed and treated hundreds of cases of degenerative disc disease and her insights about the condition sheds some light on the potential benefits of this research.
What is Degenerative Disc Disease?
Between each bony vertebral body is a disc that acts as a shock absorber and a hinge. With aging, the disc becomes dehydrated, making it less supportive and more prone to injury. Even a healthy, well-hydrated disc can be injured. The disc is composed of the annulus, which is a tough tissue that makes up the outside of the disc and the nucleus pulposus, which is the jelly-like substance in the center of the disc.
What causes these discs to degenerate?
“Degenerative changes within a disc are physiologic,” Dr. Shellock said. “This means that as our discs age, certain processes occur, including pathologic changes.
“When discs degenerate, this involves their drying out over time, losing that hydration and subsequently collapsing. This causes some bulging of the disc, which can push into the spinal canal where the neural elements are located. It can also cause tearing in the disc, which can be painful.
“As we age, we all have the potential for this condition, but it is more problematic for some. This would typically be someone who would want to be seen in the Texas Back Institute clinic.”
How is This Condition Treated?
“Our first approach for treating patients with degenerative disc disease is to treat this condition conservatively before we begin to discuss surgical options,” Dr. Shellock said. “This includes physical therapy, injections, and medications. In some cases, this conservative treatment does not help the patient.
“For example, in the case of a patient with a degenerative disc that has herniated and has caused nerve impingement, we might treat them with a microdiscectomy, which is also called microdecompression. This is a minimally invasive surgical procedure where the surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve column. Other patients who may have more ‘mechanical’ back pain with a more severe degenerative disc that has tearing of the outer lining might be a candidate for an artificial disc or perhaps a fusion, depending on the circumstances around their anatomy.”
What are the Signs of This Condition?
There are so many types of back pain, each requiring highly specific treatment. How does one know their lower back pain is being caused by a degenerative disc?
“The most common complaint from patients with degenerative disc disease is simply back pain,” Dr. Shellock said. “In many cases, this will be central back pain that can radiate to the buttocks and hip. They may or may not have leg pain with this condition. Usually, leg pain suggests more of nerve impingement syndrome.
“In many cases, patients will find the pain from this condition is exacerbated by activities that ‘load’ the spine. This includes bending forward repetitively, lifting and/or sitting for a long period of time. These types of activities will aggravate degenerative disc disease.”
Will This New Research Change Diagnosis and Treatment of This Condition?
“After reading the article about this new research, I found myself being skeptically optimistic,” she said. “The idea that some kind of imaging finding can correlate to symptomatology is certainly interesting.
“It is currently recognized by the spine community that, with standard MRI imaging, degenerative changes do not consistently correlate with symptoms. This presents a treatment dilemma for the surgeon to determine whether something which has some degenerative changes is, in fact, symptomatic.
“Clearly, more investigation is needed on the new marker, but I can envision this having a role in diagnosing a painful disc where we would otherwise have to rely on invasive studies such as discography. This procedure involves injecting dye that can be seen on a subsequent CT scan into the center of the disc(s) in question. This is the imaging part of the test. In a normal disc, without degenerative changes or tears, the dye stays in the center of the disc. If the disc has torn fibers, the dye spreads into the damaged areas. If the disc has severely degenerated, the dye spreads throughout.
“The other part of the evaluation is pain assessment. Information about the location and intensity of pain experienced during the injection helps us determine which discs are related to the pain for which you are seeking treatment.
“This new research might help us determine whether a disc that has the appearance of being degenerative is, in fact, symptomatic of the condition. I think there may be some promise, but it is certainly too early to tell.”
The Challenge of Conducting Medical Research and Treatment in the United States
The fact that this research was conducted in Hong Kong, rather than at a research or teaching facility in the United States, is indicative of the challenges facing new diagnostic and treatment techniques in this country.
“I was a little surprised it was done in Hong Kong,” Dr. Shellock said. “But at the same time, I believe they must have the volume of patients and financial resources to do the study.”
“Unfortunately, these days in this country, insurance companies are the biggest obstacles to getting patients treated. I realize that sounds ironic. However, every single day I get a notice that an MRI I ordered was denied by the patient’s insurance company. “
“Patients in this country are not likely to pay out of pocket for imaging and, perhaps, in other countries there is less expensive access to getting this imaging done. This is disappointing, especially when it comes to stifling research. Sadly, the technological advances are far ahead of when we can get approvals to use them for patient care.”
Are you experiencing back pain that has persisted for more than three weeks? If you have a family history or suspect degenerative disc disease, contact us for an appointment with Dr. Shellock or another spine specialist at Texas Back Institute.
To hear the complete interview with Dr. Jessica Shellock discussing degenerative disc disease, click on SpineTalk below.