What Is Degenerative Disc Disease?
Degenerative disc disease explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors
The spine is an important component of the skeleton, made of a number of bones called vertebrae. These “stack up” to form the spinal column, which forms the main support of the trunk and protects the spinal cord. Intervertebral discs, made up of fibrocartilage, are located between each pair of vertebrae. These function to support the spine and protect it from shocks and impact. Disc degeneration occurs when tissue is lost from a disc over time. This is known as degenerative disc disease, and may be associated with pain and other symptoms.
Disk degeneration may occur in conjunction with other conditions, including osteoarthritis. This condition also involves the loss of cartilage over time. Without this material, the bones that make up joints may come into direct contact, resulting in damage and pain.
Disc degeneration may increase the risk of disc herniation, in which the outer part of the disc material is weakened to the point where it may break or allow the inner part to “bulge” through. This condition may also contribute to the increased tightening of the spinal column around the spinal cord. This is known as spinal stenosis, and may be associated with symptoms such as chronic pain and reduced mobility.
Pain caused by degenerative disc disease may radiate outward into other parts of the body. This condition may cause different types of pain. In some cases, a stabbing pain may be felt in one area, whereas it may be duller and more diffuse in others. The condition may also result in other neurological problems, such as numbness and motor deficits.
Cause Of Degenerative Disc Disease
Many studies that investigate this disorder find that the condition is related to progressive, age-related loss of cartilage. On the other hand, some researchers find that disc degeneration is a separate condition from normal aging, indicating an actual pathology and not just wear and tear over time.
Disc degeneration may cause excess inflammation that results from the body’s attempts to heal the tissue. This inflammation affects nervous tissue in the vicinity of the disc, which is perceived as pain. Disc degeneration may also be associated with increased activity in some muscle tissue near the spine, which may also contribute to pain. This condition may also be influenced by other risk factors, such as genetics and regular smoking.
Treatments For Degenerative Disc Disease
Disc degeneration may be treated by a number of treatment options. These should be chosen in accordance with the severity of pain, the presence of symptoms such as reduced sensation, and the extent of disc tissue loss.
Many patients diagnosed with degenerative disc disease, but with mild to moderate pain, may benefit from physical therapy. This option usually involves the development of a pattern of stretching, strengthening, and conditioning exercises that reduce pain and stiffness. These patients may also try the alternation of cold and hot compresses to the affected area, which is often effective against some types of pain.
Acupuncture is another alternative therapy often used in chronic pain conditions. This uses the insertion of thin needles through the skin of affected areas. This may result in an endorphin release, which is thought to relieve pain and stress. More modern forms of acupuncture include laser, manual, and electroacupuncture.
Patients with mild to moderate pain may also benefit from some over-the-counter medications. These include non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin. These inhibit inflammation and may thus address the effects of disc degeneration. Oral corticosteroids may also have this effect. However, these medications may result in side effects such as gastrointestinal distress, organ damage, and acute headaches.
Some patients that find that drug therapy is ineffective in managing the pain of their condition could consider some minimally-invasive procedures done in a clinic setting instead. These include epidural steroid injections, in which steroids are injected near spinal nerves to inhibit pain and inflammation. The steroids may be combined with local anesthetic medications for effective pain relief that may last several weeks. Injections may be performed in repeated sessions for optimal effect.
In cases of degenerative disc disease presenting with severe pain, the patient may opt for radiofrequency ablation. This procedure involves the identification and location of nerves associated with chronic pain signaling, using imaging technology. A thin probe is then inserted through the skin under local anesthetic. When it reaches the nerve, a thermoelectric (or radiofrequency) impulse is emitted. This disrupts the nerve, thus blocking its pain signals.
Radiofrequency ablation may result in effective, long-term pain relief. However, it is associated with some risks, which include infection in the skin through which the probe was inserted, and neurological problems resulting from inaccurate probe placement.
Spinal cord stimulation is another procedure used in the treatment of degenerative disc disease. In this procedure a device that interrupts nerve impulses carrying pain signals from the spine to the brain is permanently implanted near the spinal cord. This device may be activated by the patient to deliver pain relief as needed. Spinal cord stimulation is associated with effective, long-term relief in many chronic pain conditions. There are some cases of side effects similar to those of radiofrequency ablation, which may be due to the device moving out of the desired location over time.
Surgery may be necessary in cases of disc degeneration in which motor or sensory problems arise, or that lead to other conditions such as disc herniation. Advanced disc damage is assessed with a procedure known as discography, (or a discogram) in which discs are analyzed with imaging technology. The patient’s pain may also be experimentally recreated as part of this procedure.
If a discogram shows extensive damage, herniated or degenerated disc tissue may be removed. The surgery in question is known as a discectomy. This may be combined with other procedures such as disc decompression. This helps prevent inadvertent nerve damage during surgery.
Degenerative disc disease may be associated with the loss of intervertebral cartilage with advancing age. However, some scientists argue that it is a separate condition from normal aging. Many therapies and treatments may address the pain associated with this condition. Patients with mild to moderate pain may consider conventional medications or physical therapy. Those with more extreme, chronic pain may opt for spinal cord stimulation or radiofrequency ablation. Discectomies are procedures that remove damaged disc tissue that affect normal sensory or motor functions.
- Benyamin RM, Manchikanti L, Parr AT, et al. The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician. 2012;15(4):E363-404.
- Bogduk N. Degenerative joint disease of the spine. Radiol Clin North Am. 2012;50(4):613-28.
- Erwin WM, Hood KE. The cellular and molecular biology of the intervertebral disc: A clinician’s primer. J Can Chiropr Assoc. 2014;58(3):246-257.
- Hughes SP, Freemont AJ, Hukins DW, McGreggor AH, Roberts S. The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. J Bone Joint Surg Br. 2012;94(10):1298-304.
- Kallewaard JW, Terheggen MAMB, Groen GJ, et al. 15. Discogenic low back pain. Pain Pract. 2010;10(6):560-579.
- Karppinen J, Shen FH, Luk KD, Andersson GB, Cheung KM, Samartzis D. Management of degenerative disk disease and chronic low back pain. Orthop Clin North Am. 2011;42(4):513-28.
- Lee AS, Ellman MB, Yan D, et al. A current review of molecular mechanisms regarding osteoarthritis and pain. Gene. 2013;527(2):440-7.
- Lotz JC, Haughton V, Boden SD, et al. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264(1):6-19.
- Manchikanti L, Boswell MV, Singh V, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2009;12:699-802.