Degenerative Disc Disease

Degenerative disc disease or DDD is not really a disease despite its name. It is catch-all description to those with spine disc problems. It is a describing a common diagnosis given to people with back pain and is an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain. The rubbery discs between the vertebrae normally allow for flexing and bending of the back, like shock absorbers.  In time, they become worn, and they no longer offer as much protection as before. Discs can “pancake “and flatten or they can herniate where a disc part can press on a structure.

Disc changes can include:

Loss of disc fluid: The intervertebral discs of a healthy young adult consist of up to 90 percent fluid. With age, the fluid content decreases, making the disc thinner. This is called disc dehydration. The distance between vertebrae becomes smaller, and it becomes less effective as a cushion, or shock-absorber.

Disc structure damage: Very small tears or cracks develop in the outer layer of the disc. The soft and gelatinous material in the inner part may seep through the cracks or tears, resulting in a bulging or rupturing disc. The disc may break into fragments.

When the vertebrae have less padding between them, the spine becomes less stable. To compensate, the body builds osteophytes, or bone spurs, small bony projections that develop along the edge of vertebral bones. These projections can press against the spinal cord or spinal nerve roots. They can undermine nerve function and cause pain.  These changes can affect the nerves, leading to pain, weakness, and numbness. 

Other problems include:

· a breakdown of cartilage, the tissue that cushions the joints leading to facet joint arthritis – because the space between vertebrae can diminish, it can place extra stress on the joints between the vertebrae

· a bulging disc or herniated disc

· a narrowing of the spinal canal, or spinal stenosis

What are some risk factors for developing lumbar DDD?

· Age (biggest contributor)

· obesity

· strenuous physical work

· tobacco smoking

· an acute or sudden injury, such as a fall

Degenerative disc pain can start when a major or minor injury leads to sudden and unexpected back pain, or it can present as a slight back pain that gets worse over time.

What are the symptoms?

Depending on the disc changes, pain may be limited to the back or it may radiate into one or both of the legs. The pain can be severe or mild and there may be pain free periods as well. Due to the instability of the spine, muscle spasms are also common. The pain may be worse when sitting, bending, lifting, or twisting. Walking, lying down, and changing position may help relieve it.

Treatment options?

Treatment tends to be more symptomatic. 

· Exercising the core muscles of the back and abdomen can be very helpful. 

· Epidural injections can sometimes help reduce the inflammation around nerves.

· Facet joint injections as well as rhizotomy or radio frequency ablation can help treat the pain arising from the spine joints.

· Surgery is reserved for an unstable spine or pain that is not responding to any other treatment.

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