Degenerative Disc Disease

Picture of herniated disc between L4 and L5

Degenerative disc disease occurs when the rubbery discs (between bones) in the spine wear down.

Sometimes, age can cause bones and joints to wear down. This can happen to the rubbery discs in your spine. This is called degenerative disc disease. Experts don’t fully understand why these wear down, but there are things you can do to manage your condition and symptoms.

• The discs of the spine serve as "cushions" between each vertebral segment.
• The discs are designed somewhat like a jelly donut.
• Degeneration (deterioration) of the disc makes the disc more susceptible to herniation (rupture), which can lead to localized or radiating pain. This typically occurs in the cervical spine of the neck and/or lumbar spine of the low back.
• Sciatica can result from lumbar disc herniation ("ruptured disc") or spinal osteoarthritis when nerves in the low back are irritated by the abnormal anatomy in the low back.

The vertebrae are the bony building blocks of the spine. Between each of the largest parts of the vertebrae are the discs. Ligaments are situated around the spine and discs to add stability. The spine has seven vertebrae in the neck (cervical vertebrae of the cervical spine), 12 vertebrae in the mid-back (thoracic vertebrae of the thoracic spine), and five vertebrae in the low back (lumbar vertebrae of the lumbar spine). In addition, in the mid-buttock beneath the fifth lumbar vertebra are five sacral vertebrae -- usually fused as the sacrum bone followed by the tailbone (coccyx).

The spinal discs are pads that serve as cushions between each vertebral body that serve to minimize the impact of the spinal column.

The bony spine is designed so that vertebrae "stacked" together can provide a movable support structure. The spine also protects the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebra has a bony arch behind the spinal cord that shields the cord's nerve tissue. The vertebrae also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight-bearing.

The spinal discs are pads that serve as cushions between each vertebral body that serve to minimize the impact of movement on the spinal column. Because the discs are situated between vertebrae, they are sometimes referred to as intervertebral discs. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) surrounded by a firmer ring of tissue (annulus fibrosus). With injury or degeneration, this softer component can sometimes rupture (herniate) through the surrounding outer ring (annulus fibrosus) and irritate adjacent nervous tissue. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach to each of the vertebrae and surround each of the discs. When ligaments are injured as the disc degenerates, localized pain in the area affected can result.

Cross-section picture of herniated disc between L4 and L5

As we age, the water and protein content of the cartilage of the body changes. This change results in weaker, more fragile, and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as degenerative disc disease, sometimes abbreviated DDD. Wear of the facet cartilage and the bony changes of the adjacent joint is referred to as degenerative facet joint disease or osteoarthritis of the spine. Trauma injury to the spine can also lead to degenerative disc disease.

Degeneration of the disc space and its contents is medically referred to as spondylosis. Spondylosis can be noted on X-ray tests or MRI scanning of the spine as a narrowing of the normal "disc space" between the adjacent vertebrae.

Sciatica can result from a herniated disc pressing directly on the nerve, any cause of irritation or inflammation of this nerve can reproduce the painful symptoms of sciatica.

Degeneration of the disc tissue makes the disc more susceptible to herniation. Degenerative spondylosis is another name for the degeneration of disc tissue. Degeneration of the disc can cause local pain in the affected area. Any level of the spine can be affected by disc degeneration.

• When disc degeneration affects the spine of the neck, it is referred to as cervical disc disease.
• When the mid-back is affected, the condition is referred to as thoracic disc disease. Disc degeneration that affects the lumbar spine can cause low back pain (referred to as lumbago) or irritation of a spinal nerve to cause pain radiating down the leg (sciatica).
• Lumbago causes pain localized to the low back and is common in older people.
• Degenerative arthritis (osteoarthritis) of the facet joints that can be detected with plain X-ray testing is also a cause of localized lumbar pain.

The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasms, and inflammation.

Degenerative disc disease symptoms include:

• Pain in the lower back, buttocks, neck, or thighs
• Pain when sitting that gets worse with time
• Pain that comes and goes
• Numbness or tingling in extremities
• Pain when lifting, twisting, or bending
• Pain relief during movement
• Weakness in the legs
• Foot drop, or difficulty raising the front of your foot
• Pinched or damaged nerves

Movement and switching positions often relieves pain.

Most people have some amount of disc degeneration by the age of 60, but not everyone has pain. Wear and tear on bones and joints is a normal part of the aging process. Anyone who engages in sports or has an injury to their back may develop degenerative disc disease.

Degenerative disc disease, radiculopathy, and sciatica are suspected when the symptoms described above are noted. The doctor can sometimes detect signs of irritated nerves during the examination. For example, increased radiating pain when the lower extremity is lifted supports the diagnosis of lumbar radiculopathy. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation.

Health care professionals can visualize degenerative spondylosis using plain film X-ray imaging of the spine, CAT, or MRI scanning. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.

Degenerative disc disease treatment focuses on maintaining a healthy lifestyle and relieving symptoms. You can do this with a variety of self-care practices and remedies.

The treatment of degenerative disc disease ranges from nonsurgical (medical) management to surgery. Medical management includes

• patient education about the condition,
• medications to relieve pain (Non-steroidal anti-inflammatory drugs, analgesics) and muscles spasm (muscle relaxants),
• cortisone injection around the spinal cord (epidural injection),
• physical therapy (heat, exercises, massage, ultrasound, electrical stimulation),
• chiropractic manipulation and
• rest (not strict bed rest, but avoiding reinjury).

Medications

You may be able to manage pain that lasts for a long time with over-the-counter medications or prescriptions from your doctor. These may include:

• Pain relievers like acetaminophen
• Non-steroid anti-inflammatory drugs like ibuprofen
• Corticosteroid injection into the disc space
• Prescription pain medication

Other alternative therapies like over-the-counter herbal pain creams that contain cayenne, peppermint, wintergreen, or eucalyptus and are applied locally may be useful for relieving pain.

Home care and remedies

The best way to manage degenerative disc disease is through healthy lifestyle changes. To manage pain and improve the health of your joints, you can:

• Lose weight
• Stop smoking
• Exercise
• Modify exercise that aggravates your back
• Do physical therapy exercises
• Use heat and cold therapy
• Wear a back brace

Alternative therapies

Some supplements may help relieve pain and symptoms and combat degenerative disease at an early stage. However, researchers are still studying the effects of these supplements. These include:

• Glucosamine
• Chondroitin sulfate

Other complementary or alternative therapies to manage symptoms may include:

• Acupuncture
• Massage
• Spinal manipulation
• Low-level laser therapy
• Yoga
• Tai chi
• Meditation and mindfulness
• Stem cell therapy
• Gene therapy

With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include

• removal of the herniated disc with laminotomy (producing a small hole in the bone of the spine surrounding the spinal cord),
• laminectomy (removal of the bony wall adjacent to the nerve tissues), by needle technique through the skin (percutaneous discectomy),
• disc-dissolving procedures (chemonucleolysis)
• surgical procedures are constantly being refined and you should ask your healthcare provider for the currently available surgeries

Does walking help degenerative disc disease?

Walking can help treat degenerative disc disease since it's a mild form of physical therapy, which is good for your spine and joints. Physical therapy is often the first line of defense against degenerative disc disease. Your doctor will recommend that you engage in mild aerobic activity, such as swimming and walking.

Doing a mild activity like walking can help you relieve your muscles, retain your range of movement, relieve pain, and strengthen your back muscles.

If you feel any pain or discomfort during walking, speak to your doctor about it in your next meeting. Don't push your body to extremes. Instead, try walking a few minutes a day and then increase the duration gradually.

Long-term use and overuse of pain relievers and non-steroid anti-inflammatory drugs may cause damage to the intestines and kidneys. If you are experiencing chronic and significant pain, it is important to speak to your doctor about finding new ways to manage your condition.

Supplements and herbal preparations can interact with other medications you might be on and change how they work. You should speak to your doctor before using those to make sure they are appropriate for your health.

There is always a risk to spine surgery. These may include:

• Damage to the spinal cord
• Damage to the nerves
• Infection
• Artificial disc dislocation
• Blood clots
• Spine stiffness or rigidity

The outlook of degenerative disc disease, radiculopathy, and sciatica depends on the severity of the condition, its precise cause, and the interventions used to treat the patient. When patients respond to conservative treatments, the result can be complete healing. Surgical repairs can require postoperative rehabilitation, including physical therapy.

Avoiding injury can prevent degenerative spondylosis and resulting nerve irritation. When the disease already exists, aggravation of existing symptoms can be avoided by limiting stressing or overusing the involved spine.