DEGENERATIVE DISC DISEASE

Questions and Answers

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. Similarly, 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. Then, 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.

Common Symptoms of Degenerative Disc Disease

The most common early symptom of degenerative disc disease usually occurs with patients having back pain or neck pain. Common areas affected are the cervical spine and lumbar spine. The pain often spreads to the buttocks and upper thighs, as well.  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 occur 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 a magnetic resonance imaging 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.

Degenerative Disc Disease Treatment

Treatment options 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 promptly

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.

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 a long-term health management and risk reduction program. Exercises focus on improving the strength and coordination of the lower 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

Learn more about spinal rehabilitation.

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.

Prevention

Degenerative disc disease (DDD) is a condition that affects the intervertebral discs, which are the cushions that sit between the vertebrae in the spine. As we age, the discs naturally lose water and flexibility, which can lead to a number of problems, including:

• Reduced disc height
• Disc herniation
• Bone spur formation
• Narrowing of the spinal canal (spinal stenosis)

The above changes can put pressure on the spinal nerves, causing pain, numbness, and weakness.

While there is no cure for DDD, there are a number of things you can do to prevent or slow the progression of the disease.

Here are some tips:

• Maintain a healthy weight. Excess weight puts additional stress on the spine, which can accelerate the degeneration of the discs.
• Exercise regularly. Exercise helps to strengthen the back muscles and improve flexibility. Certainly, people should aim for at least 30 minutes of moderate-intensity exercise most days of the week.
• Practice good posture. Poor posture can put a strain on the spine and increase the risk of injury. When standing, keep your shoulders back and your chest high. When sitting, make sure your feet are flat on the floor and your back is supported.
• Avoid smoking. Smoking can damage the discs and make them more susceptible to degeneration.
• Lift heavy objects properly. When lifting heavy objects, bend at the knees and keep your back straight. Lastly, avoid twisting your back while lifting.

If you have a job that requires you to sit or stand for long periods of time, take breaks to move around and stretch your back. You may also want to consider using a lumbar support pillow to help maintain your spinal curve.

If you experience any of the symptoms of DDD, such as back pain, stiffness, numbness and weakness in the arms or legs, it is important to see a doctor to get a diagnosis and discuss treatment options.

Here are some additional tips for preventing DDD:

• Eat a healthy diet. Eating a healthy diet can help to maintain your overall health and well-being, and it may also help to reduce inflammation and protect your discs. Make sure to eat plenty of fruits, vegetables, and whole grains.
• Get enough sleep. Sleep is essential for healing and repair. Aim for 7-8 hours of sleep per night.
• Manage stress. Stress can contribute to muscle tension and pain. Find healthy ways to manage stress, such as exercise, yoga, or meditation.

By following the above-mentioned tips, you can help prevent or slow the progression of DDD and maintain a healthy spine.

Degenerative Disc Disease Statistics:

Prevalence:

• Incredibly common, especially with age:
• Roughly 40% of adults over 40 have at least one degenerated disc.
• By age 80, this jumps to 80%.
• Degeneration is considered a natural part of aging, similar to wrinkles.
• Increases globally: Affects 266 million individuals worldwide each year.
• Varies geographically: Highest prevalence in Europe (5.7%), lowest in Africa (2.
• Gender differences: Generally affects women more than men. One study showed 34.7% prevalence in women vs. 18.1% in men.

Impact:

• Leading cause of back pain: Estimates suggest up to 80% of low back pain stems from disc degeneration.
• Significant economic burden: Costs billions of dollars annually in healthcare and lost productivity.
• Reduced quality of life: Can limit mobility, daily activities, and overall well-being.

Specific Conditions:

• Spinal stenosis: A narrowing of the spinal canal due to disc degeneration, affecting 103 million people globally annually.
• Spondylolisthesis: When a vertebra slips forward on another, impacting 39 million individuals worldwide each year.

Other statistics:

• Disc degeneration often starts before symptoms appear, even in adolescents.
• Degeneration may progress slowly or more rapidly depending on individual factors.
• Not everyone with degenerative discs experiences pain or limitations.
• Various risk factors contribute, including genetics, age, smoking, and obesity.

Sources:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases
• National Center for Biotechnology Information

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 is 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