The lumbar region is one of the most susceptible areas of the spine for degenerative disc disease. The disease can result in herniation of the lumbar intervertebral disc, causing debilitating pain and other symptoms. The condition is diagnosed by physical exam as well as imaging techniques. MRI, CT scan, X-ray, myelogram and discogram can be used to confirm degeneration and herniation of the lumbar spinal disc.
Pathology
It is not known what causes degenerative disc disease. With age, the discs of the lumbar spine appear to weaken. Normally, the disc forms a cushion between adjacent vertebrae, but with degeneration, the disc starts to lose mechanical strength, and the cushion effect is lost. The SpineUniverse website describes this pathology as resulting in a defect in the outer fibrous wall of the disc.
In addition, the inner, gelatinous core of the disc begins to dehydrate. The outer wall eventually forms tears, and under mechanical stress, the gelatinous interior herniates through the defect. When the herniated material pushes against the spinal cord or spinal roots, pain and other neurological symptoms begin.
Risk Factors
Degenerative disc disease is associated with age more than any other factor. SpineUniverse suggests that people under 40 who regularly lift heavy items are at higher risk for developing the disease. In addition, people who are exposed to repetitive vibration or who participate in high-impact sports are at increased risk, according to the MDGuidelines website. Other risks include smoking, diet, prior injuries and the degree of physical activity a person engages in.
Symptoms
Degenerative disc disease of the lumbar spine is usually characterized by low-grade and continuous pain in the back, which can radiate into the hips and legs. According to Cedars-Sinai, this pain can sometimes persist for days. Pain is frequently worse when the patient is sitting. Certain movements, such as bending or twisting, can make the pain worse. Sometimes changing position can make the pain dissipate. There can be periods of severe pain that come and go, or the pain can be continuous and debilitating. In more severe disc herniation, the patient may experience weakness in the leg muscles as well as sensory dysfunctions, or parasthesias.
Nonsurgical Treatment
Conservative therapy, also called nonsurgical treatment, is usually tried before surgery. Conservative options vary greatly, and according to the Mayfield Clinic of Cincinnati, such treatments can include massage therapy, resting, physical therapy, exercises and chiropractic manipulation, in addition to pain management. Nonsteroidal anti-inflammatory medicines can be taken along with pain relievers and muscle relaxants. Steroids can be injected into the spine to help manage pain. Also, back braces and electrotherapy can be employed. The rate of success of these treatments is greater than 95 percent.
Surgical Treatment
If symptoms worsen or if conservative therapy has failed, surgery is recommended. The goal of surgery is to remove the disc completely, or at least the portion that has herniated onto neural tissues. MDGuidelines notes that disc removal, or discectomy, can be followed by fusion of the vertebrae to provide stability of the spine. Metal hardware also can help stabilize the bones.
