DEGENERATIVE DISC DISEASE

Anatomy

In order to understand your symptoms and treatment options, it helps to begin with a basic understanding of your spine.  For example, this includes becoming familiar with the various parts that make up the cervical, thoracic, and lumbar sections of your spine and how these parts work together.

Learn more about the anatomy of your spine.

The main problem with degenerative disc disease lies within one or more of the intervertebral discs. Because discs exist between each vertebra in the spine, most of the mechanical stress of everyday movements gets transferred to them.  Then the discs absorb pressure and keep the spine flexible.  The discs do this by acting as cushions during body movement — similar to shock absorbers.  Without the cushion effect of the discs, the vertebrae in the spine would not absorb stress or provide the movement needed to bend and twist.

Causes of Degenerative Disc Disease

A healthy intervertebral disc has a great deal of water in the nucleus pulposus (the center portion of the disc).  Furthermore, the water content gives the nucleus a spongy quality and allows it to absorb spinal stress. Excessive pressure or injuries to the disc can cause injury to the annulus (the outer ring of tough ligament material). Usually, the annulus gets injured first — causing small tears in the ligament material.  Upon the healing of the tear, they form scar tissue, which does not have the strength of normal ligament tissue.  As more scar tissue forms, the annulus becomes weaker over time. Unfortunately, this can lead to damage to the nucleus pulposus.  Thus, it begins to lose its water content and dry up. View the image of a disc in the upper right corner of this page.

Loss of water content causes the discs to lose some of their ability to act as cushions. This can lead to even more stress on the annulus and still more tears as the cycle repeats itself. As the nucleus loses its water content, it collapses, allowing the two vertebrae above and below to move closer to one another. This results in a narrowing of the disc space between the two vertebrae. As this shift occurs, the facet joints (located at the back of the spine) are forced to shift. Shifting changes the way the facet joints work together and can cause problems as well.

Bone Spurs

Bone spurs, sometimes called osteophytes, may begin to form around the disc space. These can also form around the facet joints.  The bone spurs can become a problem if they start to grow into the spinal canal and press into the spinal cord and spinal nerves. This condition identifies a condition called spinal stenosis.

Learn more about spinal stenosis.

Symptoms of Degenerative Disc Disease

The most common early symptom of degenerative disc disease usually occurs with pain in the back that spreads to the buttocks and upper thighs. When doctors refer to degenerative disc disease, they are usually referring to a combination of problems in the spine that “start” with damage to the disc, but eventually begin to affect all parts of the spine. Problems thought to arise from the degenerating disc itself include discogenic pain and bulging discs.

Discogenic Pain

Discogenic pain refers to a term back specialists use when referring to pain caused by a damaged intervertebral disc. A degenerating disc may cause mechanical (or structural) pain. As the disc begins to degenerate, the disc itself becomes painful. Movements that place stress on the disc can result in back pain that appears to come from the disc. This occurs with other body parts that become injured, such as a broken bone or a cut in the skin. When these types of injuries occur and there is no movement, the pain will not occur.  However, if you move them they will hurt.

Discogenic pain usually causes pain felt in the lower back. It may also feel like the pain comes from your buttock area and even down into the upper thighs. The experience of feeling pain in an area away from the real cause is common in many areas of the body, not just the spine. For instance, a person with gallstones may feel pain in the shoulder or a person experiencing a heart attack may feel pain in the left arm. This refers to the radiation of the pain. When pain comes from spine problems, it can generate in different areas of the body including the back.

Bulging Discs

Bulging discs are fairly common in both young adults and older people. They are not the cause of panic. Abnormalities, such as bulging or protruding discs, are seen at high rates on MRIs in patients both with and without back pain. Some discs most likely begin to bulge as a part of both the aging process and the degeneration process of the intervertebral disc. A bulging disc does not necessarily indicate that a person has a medical emergency.

A bulging disc only becomes serious when it bulges enough to cause a narrowing of the spinal canal.  If there are bone spurs present on the facet joints behind the bulging disc, the combination may cause a narrowing of the spinal canal in that area. This often refers to segmental spinal stenosis. 

Degenerative Disc Disease Diagnosis

Before your doctor can diagnose your condition and design a treatment plan, he or she must obtain a complete health history and conduct a physical exam. However, there are so many possible causes of pain that doctors need to determine the root of the problem.  

You may take a variety of diagnostic tests.  For instance, the tests are chosen based on what your doctor suspects are causing your pain. Your doctor may order an X-ray and or an MRI scan to help him diagnose you correctly. If your doctor suspects disc degeneration, X-rays can verify a decrease in the height of space between vertebrae, bone spurs, facet hypertrophy (enlargement), and instability during flexion or extension of limbs.  An MRI can verify the loss of water in a disc, facet joint hypertrophy, stenosis, or herniated disc.

Treatment Options for Degenerative Disc Disease

Treatment will depend on the seriousness of your condition, and some problems need immediate attention —  even surgery.  For the vast majority of back problems, surgery is not considered and in some instances doing nothing will make it better.  In most cases, simple conservative therapies, such as mild pain medications and rest are effective in relieving the immediate pain.

The overall goal of treatment:

• make you comfortable as quickly as possible
• design a spine-care program to reduce further degeneration
• get you back to normal activity in a timely manner

Consequently, the more you know about how your back works and what you can do to prevent further injury, the more likely no further injuries will occur.

Specific Rest

Immediately after a back injury, you should rest because it takes the pressure off your spine.  Also, it provides all your back needs to feel better.  Of course, you should rest in a comfortable position on a firm mattress. When you place a pillow under your knees, it can also help relieve pain. Then do not stay in bed for several days. However, bed rest for more than two or three days can weaken the back muscles, making the problem worse instead of better.

Even though you may still feel some pain, a gradual return to normal activities is good for your muscles. In most cases of sudden back pain, the sooner you start moving again, the sooner your back pain will improve. If you are sent to see a physical therapist, the first part may teach you methods to take the stress off your back, while remaining as active as possible. Taking short periods of rest — combined with brief exercises designed to reduce your pain — really works.

 Epidural Steroid Injection

An epidural steroid injection (ESI) can relieve the pain of stenosis and irritated nerve roots, as well as decrease inflammation. Injections can also help reduce swelling from a bulging or herniated disc. The steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic/  The ESI is administrated through the back into the epidural space. ESIs are not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed.

Learn more about spinal injections.

Surgery

There are several surgical procedures that doctors use to help patients with degenerative disc disease, depending on the severity and location of the disease. Some common surgical procedures include:

• Spinal Fusion: The Spinal fusion procedure combines two or more vertebrae in the spine by fusing them together using bone grafts, metal plates, or screws. This procedure can help stabilize the spine and relieve pain caused by degenerative disc disease.
• Artificial Disc Replacement: Artificial disc replacement is a procedure in which a damaged disc in the spine is replaced with an artificial disc. This procedure can help restore mobility and reduce pain caused by degenerative disc disease.
• Discectomy: Discectomy is a surgical procedure in which the damaged portion of a disc in the spine is removed. This procedure can help relieve pressure on the nerves and reduce pain caused by degenerative disc disease.
• Foraminotomy: Foraminotomy is a surgical procedure in which the opening in the vertebrae where the nerves exit the spinal column is enlarged to relieve pressure on the nerves. This procedure can help reduce pain caused by degenerative disc disease.

It is important to note that surgery is typically considered a last resort for treating degenerative disc disease, and conservative measures such as pain medication, physical therapy, and lifestyle modifications are often recommended first. Additionally, each individual case is unique and requires a thorough evaluation by a medical professional to determine the most appropriate treatment plan.

Why Choose Southwest Scoliosis and Spine Institute

The spine is the specialty of our doctors and surgeons at the Southwest Scoliosis and Spine Institute. The physicians understand your concerns, can answer your questions regarding your condition, and know how to use their specialized knowledge and advanced training to assist you.  Richard Hostin, MD, Devesh Ramnath, MD, Ishaq Syed, MD, Shyam Kishan, MD, and Kathryn Wiesman, MD, have many years of training and experience in Spine and Back Pain for kids, adolescents, and adults, and can help their patients get back to living the life they enjoy.

A few of the many reasons why patients choose the Southwest Scoliosis and Spine Institute.

• Expertise in the spine: The team of specialists are recognized as spine experts.  They specialize in the diagnosis and treatment of spinal conditions, ensuring the best possible care for their patients.
• Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
• Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  We ensure that patients receive complete, seamless care for their spinal conditions.
• Dedicated facilities: Southwest Scoliosis and Spine Institute is dedicated to providing patients with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat spine patients. Southwest Scoliosis and Spine Institute doctors and surgeons are experts with offices in  Dallas, Plano, and Frisco,  TX.  They offer cutting-edge technology, comprehensive care, and dedicated facilities to ensure the best possible care for their patients. Call today to make an appointment.

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WebMD: Degenerative Disc Disease

Healthline: Degenerative Disc Disease