Degenerative Disc Disease
Intervertebral disc are tough springy disc made up of protein, cartilage and water and set between the vertebrae in the back. These discs serve as shock absorbers, hold the vertebrae together as ligaments, and allow the spine to bend and rotate. Each disc has a nucleus which is a gelatinous center high in water content which is surrounded by a fibrous cartilage like substance. There are 23 disc in the human spine, six in the neck, 12 in the mid or thoracic area and five in the lumbar or lower back area. Most pain issues occur in the lower back area which is where the highest level of weight bearing stress and movement occurs.
Degenerative disc disease occurs with ageing and is the result of a decrease in the water content of the disc which weakens the disc and makes it more brittle, thinner and less able to serve in its function as shock absorber and pivot. Degenerative disc disease is very common and in the large majority of people causes no pain. However in about 10% of the populations pain will result and sometimes be severe. Symptoms will depend on what level is affected but can include pain at the level of degeneration and numbness, tingling and weakness of the muscles supplied by that level.
Diagnosis of degenerative disc disease is made by X-ray, history, MRI and physical exam. Narrowing of the disc space can be seen on a common x-ray.
Treatment for degenerative disc disease includes rest, exercise, medications such as anti-inflammatory like Advil and Naproxen, muscle relaxant and narcotic pain relief. Physical therapy to strengthen the core muscles around the spine can be helpful and may be advised by your doctor. Epidural steroid injections may be tried if these treatments do not work to decrease pain. Smoking decreases blood flow to the disc which has limited blood supply to begin with and can possibly increase the rate of degeneration. Aerobic exercise, if tolerated, can increase blood flow to the disc and help slow degeneration. Non-weight bearing exercise such as swimming and biking can be helpful. Maintaining a normal weight decreases the load on the disc and will help in slowing degeneration. It is not completely understood why some people will have pain from degenerative disc while most people do not, however some studies find people whose family members have this problem are more likely to have it as well indicating there may be a genetic component. Also, people performing jobs that require physical labor such as construction workers are at higher risk.
Surgery is the method of last resort and statistically in studies does not provide long term pain relief. However, if functional difficulties such as muscle wasting, paralysis, or loss of bowel and bladder function occur surgery is indicated. The surgery usually performed is a spinal fusion and discectomy. Research is being done on an artificial disc which could be used as a replacement for a painful degenerated disc but it is not yet being used.
Degenerative disc disease is a common problem of ageing and will often respond to non-surgical treatment but pain may be recurrent and flare ups may occur.
Sources:
<http://arthritis.about.com/od/spine/g/ddd.htm>
<http://www.chirogeek.com/000_Disc_Anatomy.htm>
<http://ocspinaldecompression.com/degenerative.htm>
http://www.mayoclinic.com/health/search/search
Photo from wikipedia
This article is meant to be informational and is not medical advice. Always speak with your doctor regarding your medical care.
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