What Is Degenerative Disc Disease?
Intervertebral discs play a crucial role in spine health and everyday comfort. Made of fibrocartilage with a hard outer layer and a soft inner core, they sit between each bone in the spine, called a vertebra, and act as shock absorbers and cushions for the vertebrae, spinal cord and nerves.
These discs are subject to stress whenever a person stands, walks or moves. They bear part of the body’s weight and are acted upon by gravity and other forces. Over time, stress on the discs causes wear and tear–they begin to degenerate. This makes them weaker and less able to perform their functions, and may put them at risk for herniation and other problems. When disc degeneration results in pain, this is called degenerative disc disease (DDD).
Causes and Risk Factors
The hard outer portion of the disc, called the annulus, is the first part to be damaged. The annulus tears and is healed by scar tissue, which is weaker than the tissue it replaces. Degeneration can cause water content from the inner portion—the nucleus pulposus—to decrease, such that the disc becomes dried out and not as absorbent. The weakness in the outer wall may also cause the nucleus pulposus to bulge through (herniate), creating a herniated disc that presses on the spinal cord and/or a nerve.
Age is the biggest risk factor for DDD. Almost everyone over age 60 has some disc degeneration, though they may not necessarily have symptoms, according to the Arthritis Foundation.
Other risk factors include:
- Being overweight or obese, because the discs have to absorb more stress
- Having a sedentary lifestyle, because the muscles in the back deteriorate and cause the discs to work harder
- Physical labor or jobs that require repetitive bending or twisting
- Poor posture
DDD does not always result in symptoms. When it does, pain is the most iconic symptom.
The pain can range from mild to severe. It often affects the lower back but can also affect the buttocks and thighs, or it may affect the neck and then radiate out to the arms. The pain is often worse when sitting, bending, twisting or lifting something, and gets better when moving, lying down or changing positions.
Other symptoms can include numbness and tingling in the extremities, as well as weakness in the arms or legs.
The doctor will begin with a medical history and a physical exam. The patient will be asked when the pain started and the nature of the pain, and whether there is any pain when bending, twisting or otherwise moving the spine. Muscle strength and possibly nerve conduction tests may also be considered.
Imaging tests may help determine damage to the discs. An X-ray can show bone spurs, spine misalignment or a decreased amount of space between vertebrae, all either signs or complications of DDD. A magnetic resonance imaging (MRI) scan can deliver images of the disc itself.
Conservative treatment is usually attempted first. This may include:
- Physical therapy
- Hot and cold therapy
- Anti-inflammatory drugs and other pain relievers
- Epidural nerve-blocking injections,
- Facet injections or radiofrequency ablation(if there is also facet degeneration)
Getting enough proper exercise is important for a healthy spine. Exercise can help strengthen the muscles in the back, strengthen the bones and reduce the risk of falls.
Surgery is sometimes necessary for DDD, especially if it’s causing significant scoliosis or misalignment. One option is spinal fusion, where two or more vertebrae are fused together to eliminate motion in the vertebrae that causes pain.
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