Degenerative Disc Disease Treatment

Degenerative disc disease causes the soft discs between vertebrae (which act like cushions) to begin to dry out and shrink. This leads to wear and tear on the vertebrae and the discs themselves. It can lead to other problems that can put pressure on the spinal cord and nerves. The fibrous capsule surrounding these jelly-like cushions thickens, and the gel may bulge out of the discs, further contributing to discomfort and mobility issues.

Causes of Degenerative Disc Disease

Aging

As individuals age, the nutritional and blood supply to discs decrease. This reduction in essential nutrients and oxygen ultimately results in structural changes to the discs, leading to degenerative disc disease.

By understanding these various factors—genetics, environmental and lifestyle influences, and aging—patients and healthcare providers can better manage and potentially mitigate the risks associated with degenerative disc disease.

At Southwest Scoliosis and Spine Institute, our orthopedic specialists, Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD  treat patients of all ages.  These experts see this disc disease in many of our older patients.

Genetics:

Some genetic biomarkers may be associated with a greater risk of developing this condition. Genes that affect disc structure as well as genes that influence inflammation play a role in the complex pathophysiology of degenerative disc disease. Continued research on these identified genes might one day help doctors better predict who is at risk and guide the development of new treatments or preventative care.

Environment and Lifestyle:

• Smoking: This habit deprives body tissues of needed oxygen, contributing to disc deterioration.
• Obesity: Excess weight places additional stress on the spine, accelerating wear and tear.
• Physical Activities: Repeated heavy lifting and other strenuous activities can exacerbate disc wear.
• Concurrent Health Issues: Conditions like diabetes and low estrogen levels, particularly in postmenopausal women, may impact the integrity of intervertebral discs.

Other Contributing Factors:

• Poor Hydration: Insufficient water intake can affect disc health.
• Osteoarthritis (OA): Wear and tear on the spinal facet joints, responsible for free movement in the back, can lead to additional pressure and bone spurs.

By understanding these various factors—genetics, environmental and lifestyle influences, and aging—patients and healthcare providers can better manage and potentially mitigate the risks associated with degenerative disc disease. This comprehensive approach helps in crafting effective management strategies and preventative measures.

Symptoms of Disc Degeneration

This disc disease affects nearly 30 million people each year.  Over time most people will exhibit some changes in their discs due to age. However, these conditions do not always cause pain, and when they do, they vary in nature and severity.

The most common symptom of degenerative disc disease is chronic pain that periodically intensifies into more severe disabling pain.  In some cases, this disc problem can also cause weakness, numbness, and shooting pains down the arms or legs.  This pain results from the affected disc(s) putting pressure on the nerves or spinal cord.

Other common symptoms of degenerative disc disease include:

• Pain that increases during lifting, twisting, and bending motions
• A sense that the back or neck is locking up or giving out
• Muscle spasms and tension
• Sharp pains radiating to the shoulder, arm, or hand 
• Sharp pains radiating to the hips, buttocks, or down the back of the leg
• Pain that gets worse from holding certain positions, including sitting, standing, or looking down for too long

Often, the pain from a disc can get better by changing positions rather than remaining seated or standing. In addition, regular stretching and short, frequent walks may help reduce pain in the neck and lower back.

Diagnosing Degenerative Disc Disease

At Southwest Scoliosis and Spine Institute, our doctors start by carefully reviewing the patient’s medical history and discussing any symptoms they experience. For example, current and past pain symptoms, how the pain started, how often it occurs, and where the pain is felt can help the doctor to diagnose the condition and determine which discs cause the biggest concerns.

First, you will be asked for a complete physical history of your condition. This may begin by filling out a written form that asks you a number of questions relating to your pain. The more information you share with your provider, the easier your problem will be to diagnose. Your physical history helps your doctor understand:

• When the pain began
• Any potential injury that could have caused the pain
• Your lifestyle and physical factors that might be causing the pain
• Any family history of similar problems

After reviewing your written history, your physician will ask more specific questions, such as:

• When did the pain begin?
• Was there an injury that could be related to the pain?
• Where do you feel the pain? What is the intensity?
• Does the pain radiate to other parts of the body?
• What factors make the pain feel better or worse?
• Have you had problems with your bladder or bowels?
• Is there a history of osteoporosis in your family?

Then, the doctor will perform a physical exam, looking for any spinal problems and testing things like range of motion and reflexes.

Finally, imaging tests, including X-rays and an MRI scan, are used to confirm a diagnosis and determine the best treatment for each patient. While an X-ray can show any problems in the bones themselves, an MRI is typically used to show any damage to the soft tissues, such as torn, herniated, or dehydrated discs.

X-rays

An X-ray is a painless process that uses radioactive materials to take pictures of bone. If your doctor suspects vertebral degeneration, X-rays can be used to verify: a decrease in the height of space between discs, bone spurs, nerve bundle sclerosis (hardening), facet hypertrophy (enlargement), and instability during flexion or extension of limbs. X-rays show bones, but not much soft tissue, so they will definitely be used if fractures, infections, or tumors are suspected.

During X-rays, you will be asked to lie very still on a table and hold certain positions while pictures are taken of your spine.

MRI Scan (Magnetic Resonance Imaging)

The MRI scan is a fairly new test that does not use radiation. By using magnetic and radio waves, the MRI creates computer-generated images. The MRI is able to cut through multiple layers of the spine and show any abnormality of soft tissues, such as nerves and ligaments. The test also can be used to verify: loss of water in a disc, facet joint hypertrophy (enlargement), stenosis (narrowing of spinal canal), or a herniated disc (protrusion or rupture of the intervertebral disc).

During an MRI test, you lie on a table that slides into a machine with a large, round tunnel. The machine’s scanner then takes many pictures that are watched and monitored by a technician. Some newer MRI machines, called Open MRIs, are likely to be more comfortable for patients who experience claustrophobia. The procedure takes 30-60 minutes. Additional tests are sometimes used to further understand what is causing your back pain.

What is Conservative Treatment for Back Pain?

Degenerative disc disease treatment focuses primarily on reducing pain. At our practice, we always exhaust all avenues of nonsurgical treatment before considering surgery.  “Conservative treatment” refers to any treatment option that does not involve surgery. You may hear or read in your records that your provider is recommending a course of conservative treatment for your back problem. This can sometimes be as simple as reassuring you that it is not a serious issue and doing nothing but watching and waiting. However, preventive measures are usually recommended for anyone with symptomatic back problems. This often means learning how to protect your back and starting exercises to strengthen it. These exercises are quick, easy, and require no special equipment, helping to prevent future problems.

Non-surgical degenerative disc disease treatment methods your doctor may recommend include:

Pain Medications

Your doctor will most likely recommend over-the-counter pain relievers. These medications are typically recommended for mild pain, and they also help with swelling and inflammation. For severe pain, the doctor may prescribe narcotics. Prescription pain medicine is usually prescribed for short-term pain. Patients must take pain medicine as directed by their doctor.

Heat/cold treatment

Applying ice or a cold pack to a painful area of the spine can relieve pain by reducing inflammation. Using heat from a heating pad, a warm bath, or another heat source can relax the muscles around the spine. The heat can also soothe muscle tension and stop spasms that can lead to pain.

Epidural Steroid Injections

Certain injections around the protective outer layer of the spine can provide temporary pain relief. In addition, this helps to improve mobility. The doctor may recommend injection treatments prior to a physical therapy program so that it can take place with minimal pain.

Physical Therapy

Physical therapy is often quite successful at reducing the pain and other symptoms of degenerative disc disease. Also, physical therapy can help prevent or reduce further injury to the spine.

If physical therapy is recommended, your treatment plan could include one or more types of therapy:

• Modalities: Techniques such as alternating heat and ice, massage, ultrasounds, and electric stimulation.

• Bracing: Options range from a simple corset to a rigid plastic body jacket, providing varying levels of support.

• Flexibility and Strength Training: Achieved through exercises, posture retraining, and stretching to enhance core stability and overall strength.

• Pool Therapy: Utilizes water to reduce spinal pressure due to the decrease in gravity, making exercises less strenuous on the back.

• Posture Training: Focuses on learning how to stand, sit, and move properly to prevent back pain caused by poor posture.

By incorporating these types of therapy, physical therapy aims to provide a comprehensive approach to managing and alleviating back pain.

Exercise Programs

Exercises for painful degenerated discs typically include:

• Stretches: These are often useful for decreasing tension and improving spinal muscles. For cervical disc pain, stretching muscles in the neck, shoulders, and upper back can relieve pain. Stretching the muscles of the lower back, hips, pelvis, and hamstring muscles can help reduce lower back pain.
• Strengthening Exercises: Conditioning the muscles – especially those of the core – can help support the spine.

Oral Medications and Supplements

Noninvasive treatments also involve the trial of oral medications such as nonsteroidal anti-inflammatories (NSAIDs), like ibuprofen, and/or muscle relaxants. Supplements such as fish oil, which is high in omega-3 fatty acids, can also be helpful.

Injections and Radiofrequency Ablation

In addition to epidural steroid injections, facet joint injections may be used to decrease inflammation and help with symptoms. If a facet joint injection is tried but fails to provide relief, radiofrequency ablation may be used as an alternative.

Surgical Intervention

Surgery is considered a last resort if all other treatment modalities fail. This approach ensures that all non-invasive and minimally invasive options are thoroughly explored before opting for surgical solutions. Surgery for disc disease occurs when the pain gets severe and other treatments do not work after 4-6 months. It is estimated that only 10-20% of cases involving lumbar discs and up to 30% of cases involving cervical discs will require surgery for degeneration.  Surgery occurs to address the cause of pain.  For instance, a herniated disc or micromotion in the spine due to instability.

Criteria for Considering Surgery

Surgical management is reserved for motivated patients who have failed all conservative measures. This means that before opting for surgery, patients typically try options like physical therapy, medications, and lifestyle changes. If these treatments do not alleviate the pain, surgery might then be considered.

Importance of Consultation

Surgery is not for everyone, and one must consult with a surgeon to find out if he/she is a good surgical candidate. This consultation is crucial to determine the specific needs and conditions of each patient, ensuring that surgery is the most appropriate course of action.

Types of Surgical Procedures

Surgical treatment options include:

• Spinal Fusion: This usually involves the fusion of the intervertebral segment to stabilize the spine.
• Disc Replacement: Though less common, disc replacement is supported by some literature for select patients.

By thoroughly evaluating these factors and consulting with a specialist, patients can make informed decisions about whether surgery is the right option for their degenerative disc disease.

Spinal Fusion Surgery

This is one of the most common surgeries for stabilizing the spine and involves fusing two vertebrae together.  Spinal fusion uses a bone graft and screws and rods to hold the bones in place. Thus, fusing the vertebrae helps to remove micromotions and instability, and it can also help to reduce pinched nerves.

Artificial Disc Replacement

This involves removing the damaged disc and replacing it with a surgical implant designed to mimic the natural height, motion, and support of the spinal disc.

Microdiscectomy

This is a minimally invasive surgical procedure that involves making a tiny (3  to 5 mm) incision and removing a portion of a herniated disc. Minimally invasive techniques involve using highly specialized instruments and magnification to perform the surgery.  This procedure offers a number of benefits such as reduced scarring and quicker recovery times.  Also, the surgery occurs on an outpatient basis where patients go home the same day as the procedure.

The Southwest Scoliosis and Spine Institute offers minimally invasive options for many spinal procedures.  The doctor will discuss these with you when suggesting the best course of action for you.  

Preventive Measures

A variety of treatment options exist for back pain that results from degeneration (wear and tear) on the parts of the spine. In most cases, simple therapies such as mild pain medications and rest are effective. The goal of treatment is to make you feel comfortable, reduce further degeneration, and get you back to normal activity as quickly as possible. As a last resort, and only if all other conservative treatments fail, surgery might be considered.

By adopting these conservative treatments and preventive measures, you can manage back pain effectively and reduce the likelihood of further complications.

Summary

Degenerative Disc Disease is a condition that affects the spine, causing the intervertebral discs to break down and lose their cushioning ability. This can lead to chronic pain, stiffness, and limited mobility, which can make it challenging to engage in everyday activities, including intimacy. Pain associated with this disease can affect a person’s mental health, leading to anxiety, depression, frustration, resentment, and a reduced sense of self-worth. Although degenerative disc disease is not a lethal condition, it can result in significant pain which can lead to diminished quality of life.

In summary, while it won’t threaten your life, the impact on your everyday well-being can be profound. The chronic nature of the pain and associated mental health challenges can severely affect one’s ability to enjoy life fully. The  following are several good reasons why people with Degenerative Disc Disease should seek medical help from the Southwest Scoliosis and Spine Institute.

• Pain management: Chronic pain can significantly impact a person’s quality of life and mental health. Medical treatment can help manage pain, allowing individuals to engage in daily activities and improve their overall well-being.
• Prevention of further damage: Early intervention and treatment can prevent further damage to the spine and reduce the risk of complications.
• Improved mobility: Medical treatment can help improve mobility and flexibility, allowing individuals to move with greater ease and participate in physical activity.
• Individualized treatment: Medical professionals can provide personalized treatment plans tailored to an individual’s specific needs and conditions, maximizing the effectiveness of treatment.
• Mental health support: Chronic pain can take a toll on a person’s mental health, leading to anxiety, depression, and other mental health issues. Medical professionals can provide support and resources to help manage these challenges.

Conclusion

In summary, seeking medical help for Degenerative Disc Disease from the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas can provide effective pain management, prevent further damage, improve mobility, provide individualized treatment, and offer mental health support. It is important to prioritize one’s health and well-being and seek medical help to address any issues related to Degenerative Disc Disease.

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WebMD: Degenerative Disc Disease
Medical News Today Degenerative Disc Disease