Degenerated Disc Disease
A Cause Of Back Pain And Spinal Fusion
The discs in the spine act as shock absorbers between the vertebral bodies. A normal healthy disc consists of a central gel called the nucleus pulposus, which is surrounded by a firm band of fibers known as the annulus fibrosis. As a result of trauma or due to the aging process, the central gel may dry out and the fibers of the annulus fibrosis may develop cracks or tears. When this happens, the soft supple nature of the disc may be replaced by a firm rigid disc. The annular tears in the annulus fibrosis may be filled with fragments of gel from the nucleus pulposus, resulting in back pain. As the disc collapses down, this space between the adjacent vertebral bodies will decrease, resulting in foraminal stenosis and pressure upon the exiting nerve root.
Symptoms of Degenerated Disc Disease
Degenerative disc disease may result in mechanical low back pain. The degeneration of the disc itself may cause patients to have pain in that area of the spine. When the disc collapses down resulting in foraminal stenosis, the patient may experience pain in the leg or arm depending on which nerve is compressed in the foramen. Degeneration of the disc spaces does result in the patient losing height, but this is very unlikely to be noticed except that over time we all lose height as we age.
Degenerative disc disease is a result of the general aging process but it may be accelerated in cases of trauma. This trauma may be a significant injury such as a motor vehicle accident, or it may be the result of repetitive more subtle injuries, such as improper bending techniques or injury during sports. Increased body weight will also subject disc spaces, especially those of the lumbar spine which bears the weight of the body above it, to additional stress.
The first step in diagnosing degenerative disc disease is obtaining a complete history from the patient, followed by a detailed physical examination of the patient. The next step is to confirm with diagnostic studies. An x-ray of the spine will show collapsed disc spaces. A flexion/extension x-ray of the spine will show whether there is any instability of the spine. An MRI scan is a very sensitive study which will show degenerated discs.
Degenerated discs will often have changes in the bone and the end plates of the vertebral bodies surrounding them, which is known as Modic changes. A CT scan of the spine will show degenerated changes.
A discogram is a study in which fluid is injected into the disc space under pressure. The goal of the study is to determine whether the degeneration in that particular disc space is causing the pain which the patient is experiencing. The fluid will have a dye which will allow the physician to determine whether there is a crack exists in the annulus fibrosis of the disc, allowing this material to extrude through it.
Degenerative disc disease occurs in people as part of the aging process. It is certainly increased when one experiences significant trauma or less significant repetitive trauma to the spine. This may occur in accidents, or as a result of sports injuries, or due to improper bending or lifting techniques performed repeatedly. Using proper form lifting and exercising is important to avoid injury to the discs. By staying in good shape, doing proper exercise and keeping weight down, stress on the discs is reduced.
Nonsurgical management has a significant role in the treatment of degenerative disc disease. Many patients will experience flare-ups of pain which will subsequently subside. Many times the pain is manageable. Patients should avoid strenuous activity, bending and twisting during pain flare-ups.
The following measures may also be taken:
- Non-steroidal anti-inflammatory medications
- Spinal epidural steroid injections
- Oral pain medications
- Physical medicine/physical therapy techniques
- Short course of oral steroids
- Bracing or support of the spine
When the pain is significant enough to disrupt the patient's daily life, conservative measures may be unsuccessful at relieving pain and, if the pain has been present for a sufficient amount of time, surgery may be an option.
The following are surgical techniques which may improve the pain of degenerative disc disease:
- Selective endoscopic discectomy: An endoscope is passed into the patient's lumbar disc from a small incision made in the side of the patient. Part of this center of the disc is cleaned out and attempt is made to find the area of the tear in the annulus fibrosis and to coagulate this region. This is an outpatient procedure.
- Spinal fusion: A fusion is a procedure performed to immobilize two vertebral bodies around a disc space. It can be accomplished through a number of approaches which are discussed in further detail in the surgical procedures portion of this website.
The pain resulting from degenerative disease is rarely dangerous, but is rather unpleasant and annoying to the patient. If it is severe enough to require surgery, then in an appropriately selected patient, the success rate will be approximately 80% in reducing back pain.
more information on Degenerated Disc Disease or for a consultation at the Kraus Back and Neck Institute please call: