Degenerative Disc Disease
The process of degeneration of the intervertebral discs causes many problems in the spine. Everything you do during the day while being upright tests the spine’s ability to support your body weight. Minor injuries to the disc may occur and not cause pain at the time of the injury. These repeated daily stresses and minor injuries can add up over time and begin to affect the discs in your spine. The disc eventually begins to suffer from wear and tear and it begins to degenerate.
Learn about degenerative disc disease including:
- The parts of the spine affected
- Treatment options
Model of degenerative disc.
Degenerative Disc Disease
In order to understand your symptoms and treatment options, it helps to begin with a basic understanding of your low back. For example, this includes becoming familiar with the various parts that make up the lumbar spine and how these parts work together.
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 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.
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 the injury to the annulus (the outer ring of tough ligament material) that holds the vertebrae together. Usually, the annulus gets injured first — causing small tears in the ligament material. Upon the tears healing, 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 animation of degeneration 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, 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.
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 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, there will be no pain. However, if you move them they 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 be felt in different areas of the body including the back.
Bulging discs are fairly common in both young adults and older people. They are not the cause for 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 narrowing of the spinal canal. If there are bone spurs present on the facet joints behind the bulging disc, the combination may cause narrowing of the spinal canal in that area. This often refers to segmental spinal stenosis.
Before your doctor can diagnose your condition and design a treatment plan, the doctor 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 upon what your doctor suspects are causing your pain. X-rays and MRI scans appear as the most common diagnostic tests used to diagnose degenerative disc disease. 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 a herniated disc.
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.
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 on ways to take the stress off the back, while remaining as active as possible. Taking short periods of rest — combined with brief exercises designed to reduce your pain — really work.
Physical Therapy and Exercise
Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Therapy visits are designed to help control symptoms, enabling you to begin moving and exercising safely and easily. Regular exercise is the most basic way to combat back problems. Consider it part of long-term health management and risk reduction program. Exercises focus on improving the strength and coordination of the low back and abdominal muscles. The emphasis of therapy helps you learn to take care of your back through safe exercise and self-care when symptoms flare up. Scheduling of therapy sessions can occur two to three times each week for up to six weeks.
The goals of physical therapy are to help you:
- learn ways to manage your condition and control symptoms
- maintain appropriate activity levels
- learn correct posture and body movements to reduce back strain
- maximize your flexibility and strength
An epidural steroid injection (ESI) can relieve the pain of stenosis and irritated nerve roots, as well as to 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 that are given 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.