If you’re searching “What is degenerative disc disease?” you or someone you care about is experiencing neck or back pain. Understanding the causes and treatment for this disorder helps cope with and manage it.
DDD or Degenerative Disc Disease is the breakdown of spinal intervertebral discs which occurs naturally. Despite the name, DDD isn’t considered a disease and it isn’t progressively degenerative. Disc degeneration is often the effect of daily stresses and minor injuries that causes your spinal discs to lose water gradually as the rigid outer shell called Annulus weakens. Whenever the discs begin to weaken and start to lose water, they start to collapse. This causes pressure on the nerves in your spinal column which causes weakness and pain.
Pain & Quality Of Life
Although DDD isn’t always symptomatic, it can cause chronic or acute lower back or neck pain as well as nerve pain depending on the location that the affected disc is in and how much pressure it has placed on nerve roots.
Normal radiographic findings for DDD are often vacuum disc, osteophyte formation, end plate sclerosis, black discs, and disc space narrowing.
DDD can also affect your quality of life. Disc degeneration is a disease of macro/micro trauma as well as aging, although for many people it isn’t an issue, but for some it can cause chronic pain that is quite severe if it isn’t treated.
The term for DDD is a misnomer because it isn’t a disease or degenerative. It isn’t a disease because the degenerative changes within the spine are common and natural for the general population.
Disc Health & Water Loss
In your spine, there is a disc between each vertebra. A well-hydrated, healthy disc will have a lot of water in its center called the nucleus pulposus, which cushions and flexes for the spine. Much of the stress caused by daily movements is transferred to these discs and the water allows them to absorb the shock. At birth the nucleus pulposus has 80% water. But as we age, minor injuries and natural daily stresses cause the discs to lose water as annulus weakens.
The water loss causes the discs to be less flexible and causes the narrowing and collapse of the gaps in the spinal column. While the space that is between the vertebrae will start to get smaller, and this puts extra pressure on the discs which cause tiny tears and cracks to happen to the annulus. If there is enough pressure, it could cause a herniated disc.
As the vertebrae below and above the affected disc collapse, the facet joints on the back of the spine can shift which affects their function.
The Body’s Reaction To DDD
The body may react to the closing gap by creating a bone spur around the space to stop excess motion. This can cause issues if the spurs start to grow into the spinal canal and begin to put pressure on the spinal cord and nerve roots which will cause pain and affect nerve functions. It is called spinal stenosis.
For women, there is evidence that estrogen loss is associated with lumbar disc degeneration, which happens during the first 15 years of loss. The role of sex hormones in skeletal disorders are being discussed for both genders.
Symptoms and Signs
DDD can cause upper neck and lower back pain, but this isn’t always the case. The amount of degeneration doesn’t tell how much pain a patient has. Most people will have no pain while others with the same amount of damage could have chronic and severe pain. Pain will depend on where the affected disc is and how much pressure is being put on the spinal column and nerve roots.
DDD is a common source of back pain and will affect 30 million people each year. Symptomatic DDD will have varying locations of pain based on the disc location. If the disc is in the lower back, it could cause lower back pain, sometimes hip pain and pain in the legs, thighs, and buttocks. If the pressure is on the nerves, there could be weakness or tingling in the knees and legs.
A degenerative disc in the upper neck can cause pain in the hands, neck, shoulders and arm. If there are nerve issues it could cause tingling in the fingers.
The pain is often felt or becomes worse with movement like twisting, sitting, lifting and bending.
After an injury, some discs may cause pain due to inflammation and the pain will come and go. Some will have nerve endings that go deeper in the annulus than others, which make it more likely for pain to happen. Healing the trauma to the annulus may cause scar tissue and pain from the disc as the nerves become inflamed. DDD can cause a debilitating condition that may have a negative impact on your life. When pain from DDD is severe, traditional treatments are ineffective.
Mechanisms
Degenerative discs may show degenerative fibrocartilage as well as clusters of chondrocytes, which is a sign of repair. Inflammation may be present as well. Anexamination of disc fragments for DDD is common to ensure it isn’t cancerous.
Fibrocartilage will replace the mucoid material of the disc which changes with age. There may also be splits within the annulus, which causes herniation. There may also be disc shrinkage that causes folding or prolapse of the annulus that causes secondary osteophyte formations. Findings of DDD include spinal stenosis, spondylolysis, protrusion and/or subluxation of the vertebrae.
Diagnosis
The diagnosis of DDD will consist of looking at your medical history, physical exam to find poor range of motion, muscle weakness and tenderness as well as MRI to confirm and rule out other causes.
Treatment
Often DDD can be treated without surgery. A combination of treatments such as anti-inflammatory medications, physical therapy, traction, or steroid injections may give relief without causes symptoms.
Surgery may be needed if regular treatments aren’t working within a few months. If back or leg pain limits your daily activities, if there is numbness or weakness in your legs, if it is hard to stand or walk, or if the physical therapy or medication isn’t working, then surgery may be needed which is often a spinal fusion. There are multiple surgical options of DDD.
The most common treatments are:
- Cervical corpectomy: This removes part of the vertebra and intervertebral discs to decompress the cervical spinal cord and nerves. A bone graft and possibly a metal plate and screws to stabilize the spine.
- Anterior Cervical Discectomy and fusion: This uses a small incision in the front of the neck to reach the cervical spine. The intervertebral disc is removed and replaced with a plug of bone, and it will over time fuse the vertebrae.
- Foraminotomy: This enlarges the vertebral foramen to help increase the nerve pathway.
- Facetectomy: This removes part of the facet to create space.
- Dynamic stabilization: This is done after a discectomy where a stabilization implant is put in. This can be with pedicle screws or a wall ligament. These devices take pressure from the disc by rerouting the pressure. Similar to fusion, the implants allow mobility by allowing extension and flexibility.
- Laminotomy: This removes a small part of the lamina to relieve pressure on nerve roots.
- Laminoplasty: This allows the spinal canal to be reconstructed to make room for the spinal cord.
- Intervertebral disc annuloplasty: This heats the disc for 15 minutes at high temperatures to seal the disc and kill nerves that are irritated by degeneration.
- Spinal decompression: This a simple procedure that enlarges the IVF for a few hours by causing rehydration of spinal discs.
- Intervertebral disc arthroplasty: Artificial disc replacement or total replacement is a procedure that replaces discs with artificial discs in the spinal column.
- Microdiscectomy: Part of the herniated disc is removed.
- Spinal laminectomy: This treats spinal stenosis by relieving pressure. Part of the lamina is trimmed or removed to widen the spinal canal to create room for spinal nerves.
- Percutaneous disc decompression: This eliminates or reduces a small part of a bulging disc by using a needle.
- Chiropractic treatments: Chiropractors can help ease pain and manage symptoms of your degenerative disk disease.
New Treatments For Degenerative Disc Disease
There are new treatments that are coming out still in clinical trials. Glucosamine injections may give some pain relief without causing more aggressive treatments. In the United States alone, artificial disc replacement is viewed as an alternative to fusion in certain patients, yet in Europe it is more widely used, where multilevel disc replacement is quite common. Stem cell therapies for adults are still being developed.