What is Degenerative Disc Disease?

You actually don’t have to be that old in order to be complaining of an aching back. Degenerative disc disease (DDD) can occur in people as young as 20, but is typically seen in people who are older.

If you have chronic back or neck pain, you may have Degenerative Disc Disease (DDD). DDD is the normal wear and tear process of aging on your spine. As we age, our intervertebral discs (pillow-like pads between the bones in your spine) lose their flexibility, elasticity, and shock absorbing characteristics. When this happens, the discs change from a flexible state that allows fluid movement, to a stiff and rigid state that restricts your movement, therefore, causing back and neck pain.

People with DDD generally have constant back or neck pain, with occasional flares of acute pain when their “back goes out.” DDD can affect any part of the spine. The pain usually occurs in the area where there is gradual deterioration of a disc.

Common symptoms of DDD include:

More pain when sitting for a long time, bending, lifting, or twisting
Less pain when walking or running
Less pain if you change positions frequently
Less pain when you lie down

Warning Signs You Need Immediate Help

Pain is getting worse
Disabling pain
Leg weakness, pain, numbness, or tingling
Loss of bowel or bladder control

Back pain may not be just a sign of aging. To get the best treatment, your physician will first need to determine the origin of the problem in order to give you the proper diagnosis and treatment plan that is best suited for you.

Degenerative Disc Disease and Your Spinal Anatomy

In order to understand Degenerative Disc Disease, it is helpful to know the anatomy of your back. Your back (spine) is made up of many parts. Your backbone, also called your vertebral column, provides support and protection. It consists of 25 vertebrae (bones). There are discs between each of the vertebra that act like pads or shock absorbers. The discs are the source of the pain in degenerative disc disease. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus. Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. These nerves run down the center of the vertebrae and exit to various parts of the body.

Parts of the Spine

Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs.

Blood vessels provide nourishment.

These parts all work together to help you move about, and it is the same parts that can cause pain in dengenerative disc disease.

Degenerative disc disease weakens the spine, which can ultimately lead to a herniated (bulging) disc or a ruptured disc. This causes a tear in the annulus fibrosis, which causes the soft nucleus pulposus to escape either on one side or both sides. This bulge compresses the nerves. The amount of pain associated with a herniated disc rupture often depends upon the amount of material that breaks through the annulus fibrosus—and whether it compresses a nerve or not. Any of these conditions can cause inflammation and pain in degenerative disc disease.

Causes of Degenerative Disc Disease

Degenerative disc disease can be associated with an injury to the back, or it may just be a sign of aging. These changes occur over a period of time.

In the early phases of degenerative disc disease, spontaneous or post-traumatic tears, degeneration, fibrosis (hardening), and collapse of the disc may make it difficult for you to move your back freely. You may have low back pain and possibly leg pain if a nerve is squeezed; this feeling is frequently associated with degenerative disc disease. Over time, the collagen (protein) structure of the annulus fibrosus changes. Additionally, water in the discs decrease. Both of these changes reduce the disc’s ability to handle back movement.

As degenerative disc disease progresses, structures fold and buckle and bone spurs form. This can cause a narrowing of the space for the spinal cord and nerves—that disorder is called spinal stenosis. Stenosis can put pressure on the nerves in the low back.

Just like other parts of the body, each intervertebral disc has a nerve supply—the annular nerves. The inner gel-like nucleus pulposus does not have nerves, but the outer third of the annulus fibrosus does. When the disc tears or ruptures, chemicals are released, and they can irritate the nerves, causing inflammation and pain. However, it is possible to have an annular tear and have no symptoms.

In addition, herniation may put direct pressure on the nerves, causing pain in other parts of the body. This is known as radiculopathy. One area of nerves especially susceptible to injury is the cauda equina or “horse’s tail.” The cauda equina is a bundle of nerves located at lowest end of the spine, and it is made up of nerve roots and rootlets from the spinal cord above.

Exams & Tests to diagnose Degenerative Disc Disease

Call your spine specialist if you have back pain that persists or is sudden. During your visit, your doctor will ask you questions and perform some exams in order to give you a proper diagnosis of your condition. This is to try to locate the source of the lower back pain and develop a treatment plan for you—a way to manage your back pain and other symptoms of degenerative disc disease and to help you recover.

Your doctor will ask you questions about your current symptoms and remedies you have already tried (see box).

Typical Degenerative Disc Disease Diagnostic Questions

When did the lower back pain start?
What activities did you recently do?
What have you done for your lower back pain?
Does the pain radiate or travel to other parts of your body?
Does anything lessen the back pain or make it worse?
Your doctor also will do physical and neurological exams.

In the physical exam, your doctor will observe and test the following:

Your posture
Range of motion
Physical condition
Movement that causes pain will be noted
Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm.
A check of your shoulder area also done
During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread.
Your doctor may order some tests to help diagnose degenerative disc disease:
X-Ray can show narrowed disc space, fractures, bone spurs, or arthritis, which might indicate degenerative disc disease.
A computerized axial tomography scan (a CT or CAT scan) to see if there is a bulging disc
Magnetic Resonance Imaging test (an MRI) can show bulging discs and herniations.
EMG (electromyography) Test is ordered to test if there is nerve damage. This will measure how quickly your nerves respond.
Discogram or discography: A sterile procedure in which dye is injected into one of your vertebral discs and viewed under special conditions (fluoroscopy). The goal is to pinpoint which disc(s) may be causing you pain.
Bone scan: A technique used to create computer or film images of bones. A very small amount of radioactive material is injected into a blood vessel and then travels through the blood stream. It collects in your bones and can be detected by a scanner. The purpose is to help doctors detect spinal problems such as arthritis, a fracture, or infection.
Lab tests A procedure where blood is drawn (venipuncture) and tested to determine if the blood cells are normal or abnormal. Chemical changes in the blood may indicate a metabolic disorder (medical condition).

Degenerative Disc Disease - Non-Surgical Treatment Options

Degenerative disc disease is relatively common in aging adults and can be treated successfully without surgery. In fact, although 80% of adults will experience back pain, only 1%-2% will need surgery. When medical attention is needed, the majority of patients respond well to non-surgical forms of treatment, and recovery occurs in about six weeks depending on their diagnosis.

Rest: During your recovery period, your orthopedist may recommend rest or restricted activity. You may need bed rest for a few days to take the pressure off of your nerves—but you won’t be in bed for more than a few days. Extended bed rest is no longer recommended for back pain. Mild activity is preferred for better healing, and your doctor may suggest walking, bicycling, or swimming. To help you heal, you may be asked to wear a brace for back support. Medications may be prescribed such as anti-inflammatory agents to reduce swelling provide pain relief. Narcotic pain relievers may be prescribed for intense but short-lived pain (acute pain). Non-steroidal anti-inflammatory (NSAIDs) agents are available over-the-counter, but it is wise to discuss NSAID use with your doctor as they have a risk of stomach bleeding and other side effects.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) Anti-inflammatory creams, e.g. Ibuprofen 10% cream, Ketoprofen 20% topical cream, Pain relievers Muscle relaxants e.g. Flexeril Spinal injections (anesthetics, corticosteroids) Sleep aids

Physical Therapy: Your physician may also recommend you go to physical therapy for a few weeks. Physical therapy includes passive treatments such as cold or heat, deep tissue massage, electrical stimulation, and ultrasound. These treatments help prepare you for therapeutic exercise—the active part of physical therapy. Degenerative Disc Disease - Surgical Treatment Options Although most degenerative disc disease patients respond well to nonsurgical treatments, some patients need surgery. Surgery should be considered only after you’ve tried several months of nonsurgical treatment for your lower back pain. Many surgical procedures can be performed using minimally-invasive techniques. These techniques result in smaller incisions, shorter hospital stays, less pain after surgery, and a faster recovery.

If your orthopedic surgeon feels surgical intervention is needed, he or she may recommend one of the following spinal surgery techniques:

Anterior cervical discectomy and fusion: This procedure reaches the cervical spine (neck) through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone or other graft substitute, and in time, will fuse the vertebrae.

Cervical corpectomy: This procedure removes a portion of the vertebra and adjacent intervertebral discs, which allows for decompression of the cervical spinal cord and spinal nerves. A bone graft, and, in some cases, a metal plate and screws, stabilizes the spine.

Facetectomy: In this case, a part of the facet (a bony structure in the spinal canal) is removed to increase the space surrounding it.

Foraminotomy: A procedure that enlarges the foramen (the area where the nerve roots exit the spinal canal) to increase the size of the nerve pathway. This surgery can be done alone or in conjunction with a laminotomy. Laminoplasty: This procedure reaches the cervical spine (neck) from the back of the neck. The spinal canal is then reconstructed to increase room for the spinal cord.

Laminotomy: This procedure removes only a small portion of the lamina (a part of the vertebra) to relieve pressure on the nerve roots.

Microdiscectomy: A procedure that removes a disc through a very small incision with the aid of microscope. The remainder of the surgery, like more traditional discectomy, involves the removal of a portion of the lamina, the protection of affected nerves, and the removal of any herniated disc material that impinges on nerves Spinal laminectomy: Treats spinal stenosis by relieving pressure on the spinal cord. A part of the lamina (a part of the vertebra) is trimmed or removed to widen the spinal canal and create more space for the spinal nerves.

Degenerative Disc Disease - Maximize Pre- and Post-Op Wellness and Recovery

Degenerative disc disease can be a painful and debilitating condition. Once your spine specialist has outlined a treatment plan, follow the treatment plan your doctor has outlined. To recover and remain pain-free, make sure you have regular check-ups, and tell you doctor if you are not getting better. If your spine specialist has chosen surgery as your best option, there are several steps you can take to ensure your body is ready. These critical steps can make a big difference in your recovery.

Lifestyle changes are the best road to wellness.
Stop smoking if you smoke. Smoking in particular negatively impacts the process of fusion and healing, in addition to being a respiratory risk factor.
Lose Weight if you are overweight. Patients who are obese tend to have more problems with recovery from surgery, including spinal surgery. It is a simple premise--when you weight more, your body is strained every day from involuntary (heart and lung function) and daily activities (walking, lifting); with surgery, it is even a greater strain for an obese person.
Additionally, take time to learn, adjust to, and adopt habits learned in post-surgery rehabilitation that will help you preserve your spine for years to come.
Being aware of your back and its relation to overall body health can help you live a more pain-free life.

Some back problems can be lessened with simple measures:

Sit and stand properly
Exercise regularly (gentle weight-bearing exercise is especially good)
Attain and maintain a healthy weight
Stop smoking
Lift safely, using the knees

If you have been dealing with back pain for a period of time, Contact Us to schedule an appointment with our board certified spine specialist, Dr. Emmanuel. He will provide you with a comprehensive spine evaluation and outline a treatment plan that is specific to your lifestyle.