Degenerative disc disease is a condition of excessive wear and tear on the spinal discs, similar to the way arthritis affects cartilage. There is no single, defining characteristic of degenerative disc disease; it encompasses a whole range of disc abnormalities, including tears, dehydration, compression and fragmentation. It can involve a single disc or several, and can be painful or completely asymptomatic. While numerous treatment options are available, the decision of whether to treat it depends entirely on symptoms.
Is Degenerative Disc Disease Causing the Pain?
This is a crucial question that often is difficult to answer. The diagnosis of degenerative disc disease (DDD) merely describes the condition of the disc(s); it does not necessarily mean that this is the source of a patient's back pain. In fact, most people with this condition have no pain. While MRIs can diagnose DDD, it cannot indicate whether a patient's symptoms are related to the condition. Before proceeding with any significant treatment, it is critical to accurately determine the true culprit of the pain.
Approaches to Pain Relief
Treatment for degenerative disc disease generally falls into two broad categories: non-operative and operative. Non-operative treatments range from conservative to aggressive, and operative ones can be minimally invasive or more traditional. Most non-operative methods treat the pain, whereas most surgery aims to treat the underlying condition. Both are reasonable goals. The various treatment options are not mutually exclusive and often are used in combination.
Non-Aggressive Non-Operative Treatments
Therapeutic exercise and medications are the pillars of non-operative treatment. Exercises focus mainly on core stabilization and are usually extension-oriented so as to minimize the pressure on discs. The North American Spine Society also recommends low-impact, aerobic exercise such as swimming. Medications such as anti-inflammatories and non-narcotic and narcotic analgesics often are effective. Topical pain relievers such as capsaicin patches can further help relieve secondary muscle pain.
Aggressive Non-Operative Treatments
Epidural steroid injection is the most routine of this type of treatment and involves injecting medication through a needle into the spinal column. It essentially bathes the affected areas with the medicine. Intra-discal steroid injections actually deliver the medicine right into the disc. Alternative methods of pain control such as acupuncture also have been used.
Minimally Invasive Surgery
The advantages of minimally invasive procedures include fewer surgical complications, shorter recovery times and less scar tissue. A micro-discectomy is the removal of part or all of a damaged disc. Intradiscal electrothermy, or IDET, inserts a cauterizing probe in the disc to seal and shrink the disc. It is appropriate only for a selected group of patients, and results are mixed.
Traditional Surgery
When necessary, more extensive operations can be done to treat DDD. A fusion surgically locks together the vertebrae above and below the painful disc to prevent aggravating motion around it. Fusion can be done across one disc or a few. It does alter the biomechanics of the spine, however, so aside from the usual surgical risks, potential functional side effects must be considered.
Another surgical option is disc replacement, in which the degenerated disc is removed and an artificial one inserted. This aims to resolve the problem while preserving the normal function of the spine.
On the Horizon
The use of injected growth factors to spur disc regeneration shows exciting promise in ongoing studies at Rush University in Chicago. This very minimally invasive procedure will allow the disc essentially to repair itself.
