Degenerative Disc Disease

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Degenerative Disc Disease (DDD) refers to the degeneration, or normal ‘wear and tear,’ of intervertebral discs. It is one of the most common causes of low back and neck pain, and is generally, considered an unfortunate part of the aging process. Vertebroplasty

With DDD, the degeneration in the disc, or discs, leads to an inability to effectively distribute pressure through the spinal column and associated joints. Some people will experience significant pain, while others will experience none. A ‘degenerative cascade’ process begins with DDD:

  • Acute injury occurs to the disc
  • The injury causes instability of the spine and inflammation, with intermittent bouts of pain
  • With healing, the instability is corrected and fewer episodes of pain occur

Pain associated with DDD is thought to be caused by the inflammatory compression of discs, and the instability of spinal discs. This leads to a reflexive spasm of associated muscles, and it tends to be intermittent, fluctuating from minor to intense. As instability heals, however, pain generally improves with time. If pain is continuous and/or severe, it might be something other than DDD, and additional issues should be investigated.

Symptoms associated with DDD include – numbness, tingling, and radiation of pain into the limbs. If these symptoms get worse, or weakness develops, it is possible that a disc herniation has begun, compressing and possibly, damaging, nearby nerve roots.

Diagnosis and Treatment

Diagnosis of DDD is a diagnosis of exclusion, made by a doctor who takes into account history, a thorough physical exam, and imaging studies such as Magnetic Resonance Imaging. A MRI cannot diagnose DDD alone, but it can assist in creating an overall picture.

Most patients will respond with conservative management, including:

  • Activity modification, and exercise such as core strengthening and aerobic conditioning
  • Medications such as acetaminophen (Tylenol™) or ibuprofen (Advil™) can be used to manage mild chronic pain. Opioids like codeine can be prescribed for the short term relief of more severe pain
  • Physical therapy that includes therapeutic exercise, gentle stretching, electrical stimulation, traction and more can be beneficial
  • Heat and ice can be used at the site of pain to relieve inflammation

If conservative treatments fail, a variety of surgical treatment options exist for DDD2:

  • Spinal fusion of the vertebrae around an affected disc to restrict joint motion.
  • Dynamic stabilization is similar to fusion, but used more flexible materials as an internal ‘brace’
  • Disc arthroplasty, or artificial disc replacement
  • Nucleoplasty, or removal of disc material

Approximately 65% of individuals will experience improvement following surgical intervention. Sometimes, however, post-operative pain and stiffness may prevent a full return to pre-operative activity levels.

References

  1. Degeneraton Disc Disease– PainDoctor.com
  2. Ullrich, P.F. (2005) What is degenerative disc disease? Spine-Health. Retrieved from www.spine-health.com/conditions/degenerative-disc-disease.
  3. Williams, K.D.; Park, A.L. (2007). Degenerative Disc Disease and Internal Disc Derangement. Campbell’s Operative Orthopaedics, 11th Ed. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu/books
  4. Isaac, Z.; Anderson, B.C. (2011). Evaluation of the patient with neck pain and cervical spine disorders. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
  5. Anderson, B.; Isaac, Z.; Devine, J. (2010). Treatment of neck pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.