Degenerative Disc Disease
What is Degenerative Disc Disease ?
Degenerative Disc Disease (DDD) (sometimes spelled Degenerative Disk Disease) is a major cause of back pain. It is a particular type of spondylosis, where the protein and collagen structures, particularly in cartilage, gradually deteriorate with age. The intervertebral discs are affected by spondylosis, because there are more than 60 bands of collagen fibers called lamellae, which encase the water-filled nucleus. The weakening of these bands and the annulus fibrosis leads to water loss in the nucleus, loss of disc height, the reduction of distance between vertebrae, and the increased probability of a herniated disc.
Most Often Treated
Estimations say that 30% of the people between 30 and 50 years of age have some loss of disc height due to Degenerative Disc Disease. In fact, in people over 60 years of age, Degenerative Disc Disease is considered normal. However, not all of these people will experience pain or need treatment.
- Successive Micro Traumas
- Macro Trauma
Because Degenerative Disc Disease can cause spinal stenosis, all the symptoms of spinal stenosis implicates Degenerative Disc Disease. However, one must remember that Degenerative Disc Disease is not the only cause of spinal stenosis. If the patient reports discogenic pain i.e. pain originating from the disc, greater suspicion falls on a degenerated disc as the problem. Discogenic pain is limited to the lower back buttocks, thighs and groin for lumbar cases, and the back of the neck and head for cervical cases.
The most definitive tests for Degenerative Disc Disease are:
Magnetic Resonant Imaging
The T2-weighted MRI, which is tuned for the hydrogen atoms found in water, shows what is called a “black” disc, when water is absent from the disc nucleaus, which is normally bright and white in a healthy disc. This absense of water in disc is the key indication of both cervical degenerative disc disease and lumbar degenerative disc disease.
High contrast dye is injected into the suspect disc during the discogram. This dye is easily seen on a X-ray or fluoroscope and helps the doctors determine which disc(s) is involved in the patient’s pathology. This test will visually show the condition of the disc. However, the pain or lack of pain reported by the patient is a critical portion of the test.
These conservative treatments may not suffice in the long-term:
- Over-the-counter analgesic anti-inflammatory drugs
- Corticosteroid injections
- Anesthetic injections, known as nerve blocks
- Restricted activity (varies depending on extent of nerve involvement)
- Physical therapy
- A lumbar brace
Alternative therapies named here are not necessarily part of the general medical community:
- Artificial Disc Replacement
- Dynamic Spine Stabilization
- Interlaminar Decompression
All surgery carries risks from anesthesia, blood clots and infections. If complications from these risks arise, they most often can be successfully treated. The physical condition of the patient (such as obesity and diabetes) can also add risk to surgery.
Surgery Long-Term Outlook
The appropriate surgical procedure properly executed will provide long term relief for the degenerated disc(s) treated. However, if the condition was allowed to continue too long and the nerves have become damaged, there may be some remaining pain or numbness or no improvement. Also, any degenerative process will likely continue, therefore problems in other areas of the spine may appear at a later time.
What are my treatment options?