Degenerative disc disease in the back can be painful and debilitating. The condition can occur at any of the vertebral joints in the spine. To diagnose this condition, doctors give physical exams and use imaging techniques such as X-ray, MRI, discogram, myelogram and CT scan. Once the extent of the condition is diagnosed, the proper course of treatment can be prescribed.
Physiology of the Disease
The cause of degenerative disc disease is unknown, but studies have indicated a number of disease characteristics. SpineUniverse describes the intervertebral disc as a fibrous membrane surrounding a gelatinous interior. This forms cushions between the vertebrae of the spine. In degenerative disc disease, the fibrous outer membrane begins to form characteristic tears and structural defects. As the vertebrae put pressure on the disc, the softer inner material can extrude through the defect. This causes a bulge in the disc. When the bulge pushes onto neural tissues, such as the spinal nerves and the spinal cord, pain and other neurological symptoms can ensue.
Risk Factors
The older the body becomes the more vulnerable it is to degenerative disc disease, according to SpineUniverse. People who are under 40 years old and who lift heavy objects repetitively are also at greater risk for developing degenerative disc disease. In addition, people who are exposured to repeated vibrations or who play high impact sports are at increased risk, according to MDGuidelines. Other risk factors include smoking, poor nutrition and prior injuries to the neck.
Types of Symptoms
The symptoms of degenerative disc disease largely depend on the level of involvement and which neural tissues are being compressed by the bulging disc. "The British Medical Journal" states that each vertebral level can result in radiculopathy and myelopathy symptoms. These are dysfunctions related to compression of the spinal roots or the spinal cord itself, respectively. The primary symptom in each of these conditions is usually pain. Sensory dysfunctions, or parasthesias, in addition to the pain can occur from the head to the feet. Horner's syndrome and one-sided body weakness may occur. Other dysfunctions that can occur include paralysis, sensory disturbances and difficulty walking.
Non-Surgical Treatment
Before any surgery is attempted, it is usually recommended that the patient try non-surgical options, according to the Mayfield Clinic. Therapies include massage, rest, physical therapy, chiropractic therapy, exercise and pain management. Non-steroidal anti-inflammatory drugs, analgesics, muscle relaxants and steroids can also be used to control symptoms. Cedars-Sinai Medical Center says that intra-spinal steroid injections, braces, stress management, activity modification and electrotherapy can be used. The success of such conservative treatments is over 95 percent.
Surgical Treatment
When conservative treatments fail--or if the symptoms get worse--surgery is usually recommended. Surgery is performed to remove the disc or the part of the disc that has bulged and caused the symptoms. MDGuidelines says that when the intervertebral disc is removed it is often followed by grafting bone into the remaining intervertebral space and followed by vertebral fusion. Sometimes this requires metal hardware to hold the bones together. In time, the bones fuse into one solid unit, eliminating all movement between the two vertebrae.
References
- SpineUniverse: How Degenerative Disc Disease Progresses
- MDGuidelines: Displacement, Cervical Intervertebral Disc Without Myelopathy
- "British Medical Journal"; Degenerative cervical disc disease causing cord compression; P. Bently, et. al.; February, 2001
- Mayfield Clinic: Degenerative disc disease
- Cedars-Sinai: Degenerative Disc Disease
