Degenerative disc disease (DDD) is a painful condition arising from damage to the intervertebral discs. These are disc-shaped cushions of connective tissue between each vertebra. These discs act as shock absorbers and minimize the impact of movement on the vertebrae. The unique architecture of the discs prevents the vertebrae from crushing against each other under the weight of the body. However, as you age, the intervertebral discs begin to show signs of wear and tear (1). They lose their flexibility and thickness.
Some of the common symptoms of normal wear and tear of the discs include the discs shrinking, drying out or herniating. These changes in the anatomy of the discs can put pressure on the spinal nerves causing pain and numbness (2).
Although degenerative disc disease can theoretically occur at any region of the spine, it is most commonly observed in the lumbar region. As the lumbar region experiences the most stress, the intervertebral discs in this area are more prone to an accelerated degeneration. The discs have a limited blood supply and as a result, once damaged, the recovery is quite slow.
What are the causes of DDD?
The most common cause of DDD is aging. The intervertebral discs are more susceptible to damage and degradation as you age. The injury is another common cause of DDD. Excessive pressure on the intervertebral discs can lead to herniation or rupture leading to DDD. Arthritis and osteoporosis can also lead to DDD.
Some of the common are related changes in the intervertebral discs that can lead to DDD include the following.
Drying out and shrinking: Injuries and tears:
• Drying out and shrinking: Water makes up about 80% of the intervertebral discs by weight. As you age, the intervertebral discs lose this fluid and start to dry out and shrink. The shrinking reduces the cushioning between the vertebrae and leads to a decrease in flexibility.
• Injuries and tears: The anatomy of the intervertebral discs resemble that of a jelly doughnut. The softer inner part called the ‘nucleus’ is encapsulated within a tougher rubbery exterior called ‘annulus.’ The nucleus of the discs can push through the cracks or tears in the annulus causing a herniation. It can exert pressure on the adjacent nerves causing pain and numbness.
As the space between the vertebrae shrinks, the spine loses stability. The body reacts to the loss of volume between the vertebrae by synthesizing bone tissue to fill in the gap. These outgrowths (bone spurs), in turn, put pressure on the nerve endings causing pain and impaired nerve function.
Although these changes occur in most people, the extent of these changes vary. Some people are more prone to these changes than the others.
What are the risk factors for DDD?
One of the biggest risk factors in developing DDD is physical stress on the spine. People who do rigorous physical work like lifting heavy weights are more likely to damage their intervertebral discs. Similarly, overweight and obese people are more susceptible to DDD compared to their lighter counterparts. Cigarette smoking is also a risk factor in accelerating the damage to the intervertebral discs. An injury to the intervertebral discs initiates a damage that can accelerate degeneration and lead to DDD.
How id DDD diagnosed?
One of the most common symptoms of DDD is pain or numbness. The first line of diagnosis involves physical examination to identify the region of pain and muscle weakness if any. Imaging techniques such as X-ray, MRI, CT Scan, Myelogram or Discogram are then used to determine the cause and extent of the damage.
What are the treatment options for degenerative disc disease?
Disc degeneration can’t be reversed. Consequently, the treatment options involve either slowing down the degradation or surgically replacing the intervertebral disc. However, in the majority of the patients, the condition can be managed by making lifestyle changes and pain management. Surgery is recommended only if the conventional methods fail to control pain and discomfort.
Non-surgical treatment options
The non-surgical treatment options include managing the pain and implementing lifestyle changes that can reduce the pressure on the affected discs. Some of the non-surgical options include the following.
• Pharmaceuticals
Both prescription and over-the-counter pharmaceutical drugs are sued to manage the pain associated with DDD (3). Over-the-counter pain medications such as Non-Steroidal Anti-inflammatory Drugs (NSAIDS) may provide symptomatic relief. These drugs are effective in pain management if the pain is mild to moderate. Medicines in this category include Ibuprofen and Naproxen.
If the NSAIDs are not effective in the pain management, the doctors may prescribe more potent prescription pain medications including narcotics. Drugs such as OxyContin and Percocet are quite common.
Steroids are also used sometimes to reduce the swelling and pain. If the inflammation and pain are debilitating, spinal steroid injection is also quite commonly used to reduce the symptoms.
• Physical Therapy
Physical therapy can be tremendously helpful in strengthening muscles and reducing stress on the spine. Various techniques in physical therapy can provide immediate and long-term benefits in DDD (4).
Some of the techniques in physical therapy that are used to treat DDD include the following.
i. Deep tissue massage: This technique can relieve muscular spasms associated with the DDD. Deep tissue massage can restore the muscle mobility and improve muscle strength. It can also help alleviate deep muscular pain associated with disc damage.
ii. Heat and cold therapy: Both heat and cold therapy can be helpful for patients suffering from DDD. Applying heat to the affected area can increase blood circulation and can flush out the pain causing chemicals such as lactic acid. On the other hand, cold therapy restricts the blood flow to the injured area thereby reducing the inflammation. A physical therapist may use both heat and cold therapy alternatively to achieve the maximum benefit.
iii. Physical exercise: Physical exercises to improve muscle strength and reduce stress on the spine are particularly beneficial for the DDD patients.
• Alternative treatments
Several alternative treatments can also help people suffering from DDD to manage the symptoms. Chiropractic spinal alignment can relieve undue pressure on the discs and reduce pain. Acupuncture and other holistic treatment options are also available for the symptomatic management of DDD.
• Surgery
Although surgery is not recommended for most of the patients with DDD, it can offer a permanent relief for individual patients (5). As spinal surgery is a major procedure, you should consult with your Michigan pain doctor and consider all aspects before deciding. The most common surgical procedures to treat DDD include the following.
Spinal FusionArtificial disc replacement
1. Spinal Fusion: In this procedure, two or more individual vertebrae are fused together to avoid painful movement altogether. The process decreases the ability to rotate your spine and can cause undue pressure on other regions of the spine.
2. Artificial disc replacement: This procedure involves the replacement of the damaged disc with an artificial material that mimics the natural intervertebral discs. This procedure can restore most of the usual function over time. The artificial discs are made from a material that is like the natural cartilage in the intervertebral discs in consistency and strength.
References:
(1) Raj, P. P. (2008). Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Practice: the Official Journal of World Institute of Pain, 8(1), 18–44. http://doi.org/10.1111/j.1533-2500.2007.00171.x
(2) Chapter-01 Back Pain, Sciatica and Herniated Lumbar Intervertebral Disc Historical Anecdote. (2014). Chapter-01 Back Pain, Sciatica and Herniated Lumbar Intervertebral Disc Historical Anecdote (pp. 1–3). http://doi.org/10.5005/jp/books/12000_1
(3) Sonntag, V. K. H. (2010). Treatment of the Herniated Lumbar Disc: Persistent Problem. World Neurosurgery, 74(6), 574–575. http://doi.org/10.1016/j.wneu.2010.08.006
(4) https://www.spineuniverse.com/conditions/herniated-disc/physical-therapy-herniated-discs
(5) Ramadan, A., Hassan, A., & Khalaf, N. (1997). Indications for surgery for herniated lumbar disc. Clinical Neurology and Neurosurgery, 99, S163. http://doi.org/10.1016/S0303-8467(97)82023-9