All about degenerative disc disease

Degenerative disorder is an age-related disease that occurs when one or more of the discs between spinal column vertebrae deteriorate or break down, leading to pain.

The weakness, numbness, and pain that radiates down the leg may be present.

Degenerative disc disease, despite its name, is not a disease but a natural occurrence that comes with age.

Normally, the rubbery discs between the vertebrae cause the back to stretch and bend, like shock absorbers. They get worn out in time, and they no longer have as much protection as before.

Treatment

Treatment may include occupational therapy, physical therapy, or both, special exercises, medications, losing weight, and surgery.

Medical options include injecting the joints next to the damaged disc with steroids and a local anesthetic. These are called facet joint injections. They can provide effective pain relief.

Facet rhizotomy is a radiofrequency current that deadens the nerves around the facet joint, preventing pain signals from reaching the brain. Patients who respond well to facet joint injections may benefit from these. Pain relief may last for more than a year.

Intradiscal electrothermal annuloplasty (IDET) involves inserting a catheter into the disc and heating it. This appears to reduce pain, possibly by causing collagen to contract so that it repairs damage in the disc. The exact mechanism remains unclear.

Medications include pain relief medication, such as Tylenol, and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Steroids and muscle relaxers may also be prescribed.

Some positions can help relieve symptoms. Kneeling or reclining, for example, may be less painful than sitting.

A corset or brace can offer support for the back.

Symptoms

No symptoms may be caused by disc degeneration, or the pain may be so severe that the person can not continue with their daily activities.

The disease begins with spine damage but symptoms can affect other areas of the body in time. Typically, symptoms get worse with age.

The pain can vary from mild to extreme, and may weaken. It can cause osteoarthritis, with back pain and stiffness.

The most common early symptom is usually back pain and weakness which radiates to a different region.

The pain can radiate to the buttocks and upper thighs if the damage is to the lower back, or to the lumbar spine. Tingling, numbness, or both, in the legs or feet may also be present.

The pain can spread to the shoulder , arm, and hand if the damage is in the neck area, or cervical spine.

Instability can also occur in the spine, leading to muscle spasms in the lower back or neck as the body attempts to stabilize the vertebrae. That could be painful.

Flareups of extreme pain can be experienced by the person.

When sitting, leaning, raising, or spinning, the pain can be greater. It can help to alleviate it by walking, lying down, and changing position.

Causes

The padding between the spine vertebrae is provided by intervertebral discs, also known as intervertebral fibrocartilage or spinal discs. They are made of fibrocartilage tissue and have an elastic structure.

The outer part of the disc is known as the fibrosus annulus. It is rough and fibrous, and has many overlapping layers.

The nucleus pulposus is the inside center of the disk. It is gelatinous and smooth.

When the spine shifts or carries weight, the intervertebral discs buffer the Stress. Even they help to bend the spine.

When people age, the discs in the back can be weakened by constant regular pressures on the spine and occasional injuries, even minor, overlooked ones.

• Loss of fluid: The intervertebral discs of a healthy young adult consist of up to 90 percent fluid. With age, the fluid content decreases, making the disc thinner. The distance between vertebrae becomes smaller, and it becomes less effective as a cushion, or shock-absorber.
• Disc structure: Very small tears or cracks develop in the outer layer of the disc. The soft and gelatinous material in the inner part may seep through the cracks or tears, resulting in a bulging or rupturing disc. The disc may break into fragments.

The spine becomes less secure as the vertebrae have less padding in between them. 

The body constructs osteophytes, or bone spurs, small bony extensions that form around the edge of the bones, to compensate. These projections can press against the spinal cord or spinal nerve roots. They can undermine the role of nerves and cause pain.

Other problems include:

• a breakdown of cartilage, the tissue that cushions the joints
• a bulging disc, known as a herniated disc
• a narrowing of the spinal canal, or spinal stenosis

These changes can affect the nerves, leading to pain, weakness, and numbness.

Risk factors

Age is the biggest risk factor, but some other factors can speed up the process of degeneration.

These include:

• obesity
• strenuous physical work
• tobacco smoking
• an acute or sudden injury, such as a fall

Degenerative disc pain may begin when a major or minor injury results in sudden and unexpected back pain, or it may manifest as a mild back pain that gets worse over time. 

Diagnosis 

The doctor will inquire about the signs, where and where the pain happens, whether tingling or numbness happens and which circumstances cause the greatest pain. They will also ask about any falls, injuries, or accidents.

A physical examination may assess for:

• Muscle strength: The doctor may check for atrophy, wasting, or abnormal movements.
• Pain with motion or in response to touch: The patient will be asked to move in specific ways. If pressure applied to the lower back causes pain, there may be a degenerated disc.
• Nerve function: The physician taps different areas with a reflex hammer. Poor or no reaction could indicate a compressed nerve root. Hot and cold stimuli may be used to see how well the nerves react to temperature changes.

The doctor may order the following diagnostic tests:

• Imaging scans, such as CT or MRI, to gather information about the state of the spinal nerves, the discs, and how they are aligned.
• A discogram, which involves injecting a dye into the soft center of the disc, or several discs. The aim is to see whether the disc is painful. The dye shows up on a CT scan or X-ray. Discogram usage may be controversial, however, because herniated discs do not always cause symptoms.

To ensure a accurate diagnosis, the doctor can also test for other conditions, such as a tumor or other types of damage.

Exercises

Exercises can help reinforce and strengthen the region around the damaged disks, and enhance mobility. 

Exercises that develop the back and stomach muscles include walking, riding, and swimming, as well as core programs such as yoga and pilates for strengthening. 

The National Health Service of the United Kingdom (NHS) suggests a few basic exercises to try at home. 

Lie on the floor or on a bed on your back, with your feet flat on the floor. 

1. Press the lower back down on the floor. Take 5 seconds to carry. 10 times to repeat. 

2. Squeeze the buttocks together in the same place, and raise them gently to make a low bridge. Only squeezing the buttocks will help if it is hard to create a bridge. Do 10 times this. 

3. Shift the knees from side to side gently. 

Weights lifting can help, but this has to be done under supervision and without bending the body. 

Surgery 

Surgery can be suggested in patients who do not respond to conservative therapies within about 3 months.

This may be an option if there is:

• back or leg pain that stops the patient from carrying out regular activities
• numbness or weakness in the legs
• difficulty standing or walking

The following surgical options are available:

Surgery for stabilization or spinal fusion: fusing two vertebrae together provides the spine with stability. 

This can be done anywhere in the spine, but in the lower back and region of the neck it is more common. These are the most movable spine pieces. 

In patients whose spine can no longer bear their weight, this can alleviate intense discomfort, but it can also worsen the degeneration of the disks adjacent to the fused vertebrae. 

Decompression surgery: Different methods for removing part of the disk joint may alleviate nerve pressure. 

Other methods of treatment may be appropriate for a patient experiencing osteoarthritis, a herniated disc, or spinal stenosis. 

Stem cell therapy 

Researchers at Queensland University , Australia, have had some success in using stem cells as a tissue engineering method. 

The goal is to promote the development of usable cartilage, using an injectable hydrogel method. The researchers concluded that stem cell therapy could be helpful for the regeneration of intervertebral discs. 

The verdict is still out and a lot more trials are required to prove this safe and successful treatment.