Degenerative Disc Disease

Degenerative Disc Disease isn't a disease, but a condition. As we age, discs often degenerate as the soft, spongy nucleus (the inner ring of the disc) loses moisture and resiliency and the ligaments of annulus (the outer ring of the disc) become brittle and subject to tears. Many individuals who have Degenerative Disc Disease have no pain and no symptoms. Many who do suffer pain find the discomfort decreases over time.

Degenerative changes in the spine are often referred to those that cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear aging, even misuse (e.g. smoking).

Long before Degenerative Disc Disease can be seen radiographically, biochemical and histologic (structural) changes occur. Some of these changes are not unlike those associated with osteoarthritis.

Over time the collagen (protein) structure of the annulus fibrosus weakens and may become structurally unsound. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc’s inability to handle mechanical stress. Understanding the lumbar spine carries a large portion of the body’s weight; the stress from motion may result in a disc problem (e.g. herniation).

Non-Operative Treatment: Yesterday vs. Today

DDD is a disorder that may cause low back pain. It is interesting to note that although 80% of adults will experience back pain, only 1-2% will need lumbar spine surgery!

In the past some physicians prescribed long courses of bedrest and/or lumbar traction for their patients with low back pain. However, that is not the attitude today. During the acute phase, bedrest may be recommended for a few days, but beyond that experts advocate stretching, flexion and extension exercises, and no/low impact aerobics. Of course, each patient is different and therefore so is their treatment plan.

Therapeutic Exercise

In some patients, the pain response may limit their flexibility. Prescribed stretching exercises can improve flexibility of the trunk muscles. Flexion exercises may help to widen the intervertebral foramen. The intervertebral (between the vertebrae) foramen are small canals through which the nerve roots exit the spinal cord. The intervertebral foramen are located on the left and right sides of the spinal column.

Extension exercises, such as the McKenzie method, focuses on the muscles and ligaments. These exercises help maintain the spine’s natural lordotic curve, important to good .

Aerobics (no/low impact) offers many benefits including improved muscular endurance, coordination, strength, strong abdominal muscles, and weight loss. Strong abdominal muscles work like a brace (or corset) to reduce the loads to the lumbar spine. It is also known that aerobics help to combat anxiety and depression. The loads on the discs during walking are only slightly greater than when lying down. Walking, bicycling, and swimming are forms of aerobic exercise a physician may suggest.

Acupuncture

Acupuncture, a type of alternative medicine, has been shown to control pain. It has been suggested that acupuncture stimulates the production of endorphins, acetylcholine, and serotonin. However, acupuncture should be combined with an exercise program for many of the reasons outlined in prior paragraphs.

Drug Therapy

During the acute phase of low back pain, drugs may be prescribed. Some of these may include narcotics, acetaminophen, anti-inflammatory agents, muscle relaxants, and anti-depressants. Narcotics are used on a short-term basis partially due to their addiction potential. When low back pain is caused by muscle spasm, a muscle relaxant may be prescribed. These drugs have sedative effects. Depression can be a factor in chronic low back pain. Anti-depressant drugs have analgesic properties and may improve sleep.

Manipulation

Today manipulation is performed by Chiropractors and Physical Therapists. For patients without radiculopathy (pain stemming from a spinal nerve root), manipulation may be effective during the first month. Thereafter, benefits are unproven. Manipulation is believed to be effective because of its effect on spinal mobility. Acute low back pain, chronic low back pain, and DDD without nerve compression may respond to manipulation.

Now for some people they may never have any pain from their DDD while others it will be intolerable. Obviously it is up to the person suffering to decide what if any courses they will take to relieve the pain.

In association with all the other problems I have I also have DDD in most of the lumbar spine. Now oddly it was not there in the original x-rays or CT Scans I had prior to the surgery, it was not there 3 months after the surgery but when I had the MRI done in August of 2004 it was there.

What I found out later on was that when you have spinal surgery it is possible post op to develop new problems right above and/or below the surgical site. So when they completed the surgery on my L5/S1 basically what happened was the rest of the lumbar spine started to fall apart. The MRI showed degenerative discs from L1-L4 as well as herniation at one level.

Now these are most likely not the contributing to the pain I experience since the location of the pain does not correspond to the nerve roots from the L1-L4 as well the EMG has shown the L5/S1 roots to be damaged, a sure sign that it is indeed arachnoiditis. What is really amazing is the number of people who may suffer from DDD as well as a myriad of other back problems but they never know it nor do they exhibit any signs like pain or weakness.