Degenerative Disc

With advancing age, changes in physiology and “wear and tear” can affect the spine. Particularly vulnerable to age-related degeneration are the discs or little cushions that separate the vertebrae and act as shock absorbers. These discs act as spacers between the vertebra bones and help the spinal column deal with the pressures of walking, running, and movement.

Discs serve a valuable and unique purpose in the body, but if they are damaged, rupture, become brittle or misshapen, they lack the ability to repair themselves. DDD may lead to discs that are:

  • Dried out (less fluid inside and less ability to absorb shock)
  • Flattened (providing less spacing between vertebrae)
  • Stiff (less cushion)
  • Bulging out or otherwise misshapen
  • Broken open (ruptured or herniated)

Causes

By far the most common cause of DDD is aging. Even if there is no direct damage to the disc, the stiffening and wear of tissue in all parts of the body can cause sufficient stress on the disc to cause microscopic tears or flattening out of the disc. DDD can also occur in response to repetitive stress on the spine.

 

Terminology

Between every pair of vertebrae in the spinal column is an interspinal disc or disc. The disc consists of a rigid, rugged ring-like structure (the annulus fibrosus) and a gel-like substance in the center which acts like a cushion (nucleus pulposus). Degenerative disc disease (DDD) is a general term used to describe deterioration of the disc, often due to aging or general “wear and tear”. Technically, DDD is a syndrome and not a true “disease.”

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In some cases of DDD, the nucleus pulposus inside the disc can leak out when the disc herniatesor ruptures. If this substance comes in contact with nearby nerves, it can cause irritation,inflammation, and considerable pain. Since the spinal column is the “nerve center” of the body, ruptured discs are very likely to irritate nearby nerves.

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Symptoms

Degenerative disc disease may be challenging to diagnose at first because the symptoms may come on gradually and be dismissed at first, particularly in seniors who accept some “aches and pains” as a normal part of growing older.

The pain of degenerative disc disease may be mild to severe. In some people, it is a dull ache, but in others the pain can be sharp and incapacitating. The pain is typically localized to the area affected, that is, if the degenerative disc disease occurs in the lower back, the pain will be in the lower back. In some cases, people with degenerative disc disease may find pain relief by lying down.
In more severe cases, there may be numbness, tingling, “pins and needles,” or weakness in the arms and hands or legs and feet.

Treatment

The treatment of degenerative disc disease will depend greatly on the patient’s overall condition, the severity of symptoms, the location of the problem, and the patient’s preferences. There are many treatment options available for patients with DDD and the Neuro Spinal Hospital can offer guidance in terms of the most appropriate treatments for an individual patient. Treatment options include:

  • Conservative treatment
    • Bed rest
    • Activity restrictions
    • Pain relievers
    • Anti-inflammatory medications
  • Physical therapy
  • Epidural steroid injections to manage pain and inflammation
  • Surgery, including minimally invasive procedures

There are actually several types of surgeries that can be helpful to relieve the pain and other symptoms of degenerative disc disorders. They include:

  • Minimally invasive interbody fusion
  • Artificial disc replacement
  • Discectomy
  • Laminectomy

Minimally invasive interbody fusion removes the damaged disc and then joins the two vertebrae together (fusion) using an implantable device as a spacer and stabilizer. It can be performed with only a small incision and may be done on an outpatient basis in appropriate candidates. In other cases, the damaged disc is removed and replaced with an artificial disc to provide support and spacing. A discectomy refers to the removal of the disc which may be followed by fusion. Laminectomy is a procedure in which part of the bone of the vertebra is removed in an effort to relieve compression on the nerves.

Many people with degenerative disc disease have found relief in surgery, but not all patients are appropriate candidates for surgery.

Prognosis

Degenerative disc disease (DDD) is an age-related process and individuals who develop this condition in one area of the spine may have it recur in another. However, DDD can be effectively treated, even if treatment is conservative and focuses mainly on pain management. Most people living with DDD can find significant, if not total, relief from DDD symptoms with proper treatment.

Risk Factors

The most common risk factors for degenerative disc disease (DDD) are advancing age and repetitive stress on the spine.

Conclusion

Degenerative disc disease (DDD) is technically a syndrome and not a disease and involves age-related or repetitive-stress-related changes to the interveterbral discs that help to cushion the spine. DDD can reduce the discs’ function, causing pain and limiting mobility. While DDD cannot be prevented, it can be treated either with conservative treatments (including pain control) or surgery. The Neuro Spinal Hospital can help advise patients with DDD about the most appropriate treatment options.

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