What is Degenerative Disc Disease?
Degenerative Disc Disease results from wear and tear of one or multiple vertebral discs. The vertebral discs exist between the bones of the spine to provide cushioning and help facilitate movement between the spine levels. Degenerative Disc Disease (DDD) can develop as a normal part of the aging process, but it can also result from injury.
The two main symptoms of DDD are pain and stiffness. The stiffness can often be worse after prolonged sitting or standing. Occasionally, bending, twisting and sitting may make the pain worse. Degeneration can occur throughout the spine but is most likely to occur in the cervical and lumbar spine.
- Cervical Spinal DDD
The cervical spine consists of seven upper vertebrae sections designated as C1 to C7. These discs commonly bulge and degenerate as we age. Two associated conditions can include cervical myelopathy and cervical radiculopathy. Cervical myelopathy is when spinal compression in the middle part of the neck creates an impaired function in the extremities.
- Lumbar Spinal DDD:
The lumbar vertebrae consist of five sections at the base of the spine designated as L1 to L5. Those suffering from lumbar spinal stenosis may experience numbing, pain, and loss of function in the legs. Frequently, persons can have mild spinal stenosis associated with no symptoms. One associated condition, is degenerative spondylolisthesis. Degenerative spondylolisthesis occurs when one vertebra “slips forward or backward” over on to another. This can be a painful conditions which can also occur in the cervical spine and can be related to whiplash injuries.
Causes and Risks
Degenerative disc disease typically begins with a reduction in the volume of the nucleus pulposus. The nucleus pulposus is comprised of a gel-like substance that is responsible for absorbing shock. Disc degeneration is the process of having less of this nucleus pulposus material as well as a change of the material to be more rigid and less flexible as it loses water content as we age and becomes firmer. In DDD the height of the disc is reduced and thus there is less cushioning between the spinal levels. This can lead to more force being passed on to the adjacent bone, causing inflammation and pain. As this cushion degenerates, the disc is no longer able to perform its main function of absorbing shock and allowing movement between spine segments. The vertebrae above and below this damaged disc are then able to move closer together. This causes the space for the nerves to exit the spine, known as the neural or intervertebral foramen, to become narrowed and possibly pinch the exiting spinal nerve roots. Additionally, the facet joints (joints between the vertebral bones) can also become stressed or shifted, resulting in stiffness and pain. The stress of this process can cause bone spurs to the form. The spurs may lead to additional loss of segmental motion of the disc and joints. The stiffened spinal level can then lead to more force on adjacent levels in the spine.
Treatments and Prevention
- DDD can be diagnosed with Xray, CT scan, or MRI.
- Physical therapy and home exercises that focus on strengthening and increasing the flexibility of the muscles surrounding the core and back.
- Prescription medications, such as oral anti-inflammatories, nerve blockers, and muscle relaxants may help reduce pain. Patches and creams can also be applied to the skin directly to the area of pain.
- Facet joint injections may reduce swelling and relieve pressure on the joints that are causing pain due to DDD.
- Radiofrequency ablation of the nerves that go to the facet joints can offer more long-lasting pain relief.
- Inflammation nerves at the level of DDD can be treated with epidural steroid injections.
- Regenerative treatment, such as PRP can be used to reduce pain in the spinal ligaments and facets that are compromised due to DDD
- Alternative Therapies: Acupuncture, herbal remedies, massage and/or chiropractic manipulation.