Degenerative disc disease is associated with wear and tear of the spinal discs with age, which causes pain. Each intervertebral disc of the spine is made up of a soft inner layer and a firm outer layer. They contain fibrocartilage to support movements and provide flexibility. Disc degeneration is part of the natural aging process and nearly occurs in all individuals as they age. However, the nature and severity of the disease may vary and not everyone experiences pain.
Causes and risk factors of degenerative disc disease
The following are some of the ways that may cause degenerative disc disease:
- Age related wear and tear: As age progresses, the outer firm layer around the discs wears out and increases stress on the spine. These discs act as shock absorbers and fail to provide protection with increasing age.
- Injuries: Minor injuries and stressful movements in everyday life may cause cracks in the outer layer of the discs over time. The outer layer contains nerves and any tears or cracks occurring in close proximity to the nerves can cause pain.
- Loss of water content: During younger age, the intervertebral discs contain major amounts of fluid. As age increases, the water content in the discs is decreased, making them thinner and flatter. Thinner discs fail to provide enough support.
Some health and lifestyle-related risk factors may have a negative impact on the spine and eventually lead to degenerative disc disease. These include:
- Obesity
- Sports and exercises involving strenuous movements of the lower back
- Stress on the lower back due to poor postures and long periods of sitting in one position
- Genetic predisposition
- Unsupported discs due to lack of strength in core muscles
- Smoking
Symptoms of degenerative disc disease
The precise symptoms of the condition depend on the location of the damaged disc and the associated changes. Some common signs and symptoms include:
- Sharp pain in the back and neck.
- Intermittent episodes of moderate to severe pain.
- Pain which worsens with specific movements such as bending, lifting or twisting.
- Tingling and numbness in legs and feet.
- Pain which is relived while lying down.
- Radiating pain from lower back to arms, hands, thighs, buttocks or neck.
- Weakness of legs
Diagnosis of degenerative disc disease
Diagnosis is carried out based on signs and symptoms, medical history and physical examination. Physical examination may include assessment of muscle strength, location, and pain specificity with particular movements and reflexes to evaluate nerve function.
Diagnostic imaging scans including radiographs, CT-scans and MRIs may be ordered by the doctor to study the structural alignment and rule out any other possible diagnosis. Discography is an important diagnostic test in patients presenting with symptoms but show poor response to conservative treatment.
Treatment of degenerative disc disease
The treatment of degenerative disc disease is divided into three approaches: Pain management, physical therapy and lifestyle modifications and surgical interventions.
Pain management: The different means of pain management include pain relief medications, heat therapy, cold therapy and epidural steroid injections.
Physical therapy & lifestyle modifications: Physical therapy includes strengthening and stretching exercises for the back and the neck to improve flexibility. Lifestyle modifications include avoiding smoking, weight control, following correct sitting postures and using the right equipment to support the spine and neck.
Surgical interventions: Surgical interventions are only indicated when patients do not respond to conservative treatments of pain management and physical therapy. The common surgical interventions for degenerative disc disease are spinal fusion and artificial disc replacement.
Discectomy is often carried out for the treatment of herniated disc which may occur due to degenerative disc disease. Transforaminal Lumber interbody fusion is a minimally invasive endoscopic technique for patients with pain associated with degenerative disc diseases.
