WHAT IS DEGENERATIVE DISC DISEASE (DDD)?

Degenerative disc disease is a medical condition that occurs when there is a gradual deterioration of the inter-vertebral disc. These discs in the spine absorb shock between vertebrae, thereby keeping your back flexible and straight. However, patients with DDD experience pain when bending or standing up straight due to wear and tear of the vertebral discs.

Risk factors.

Age is the primary risk factor that predisposes someone to DDD. Other risk factors include obesity, tobacco smoking, strenuous physical activities, and acute injury like a fall. These factors speed up the discs’ degeneration process and predispose people to an early onset of DDD at a young age. Furthermore, a major or minor injury to the back can lead to unexpected and sudden pain. Conversely, a slight pain from a back injury can progress and worsen over time.

Pathophysiology and causes of DDD.

Inter-vertebral discs contain elastic fibrocartilage tissue. Annulus fibrosus is the exterior part of the spinal disc, while the inner part is the nucleus pulposus. The annular fibrosis has overlapping layers and is fibrous and robust, while the nucleus pulposus is gelatinous and soft. Changes in these two sections of the spinal discs result in DDD. When the discs crack or become dry, the symptoms of DDD appear, and the patient feels intense back pain. The nucleus pulposus of healthy people has more than 90 % fluid.

The fluid content of the disc decreases with age. Therefore, when there is a loss of fluid, the hydrostatic pressure reduces, resulting in thinner spinal discs, thereby making it a less effective shock absorber. DDD might occur from tears in the annulus fibrosus where the fluid from the nucleus pulposus seeps through and causes disc bulging. Eventually, accumulated fluid from the inner core might prompt the spinal disc to break or rupture into several fragments. If these tears occur near a nerve ending, it can result in severe pain. Furthermore, bulging inter-vertebral discs can slip and cause a herniated disc that might affect or rapture nearby nerves. Severe degeneration can result in osteoarthritis due to the collapse of the inter-vertebral disc. Spinal disc receives little blood supply, and thus these changes can affect the repair process due to interference of blood supply. Therefore, injury to the discs produces permanent damage that is difficult to reverse. The body typically builds osteophytes as compensation for less cushion produced by the thin spinal discs. The osteophytes act as projections in the inter-vertebral space and press against spinal nerve roots, thereby resulting in pain. The projection can cause spinal stenosis due to the narrowing of the spinal canal. Eventually, these changes progress to cause increasing pain, numbness, and weakness due to interference with nerve function.

Symptoms.

The primary manifestation of DDD is pain and weakness that starts in the back and radiates to other areas. Some patients might not manifest with back pain or any other classical symptoms. The manifestation of DDD worsens with age as it progresses and affects other areas of the body apart from the spine. Damage of cervical discs causes the spread of pain to the arm, shoulder, and hand. When there is damage to the lumbar inter-vertebral discs, pain radiates to the upper thighs and buttocks. Furthermore, the patient might experience numbness or tingling of the legs. Pain in DDD patients intensifies with activities such as lifting, twisting, bending, or sitting. Patients might alleviate discomfort by lying down or walking.

Diagnosis.

A physician can perform a physical exam or use diagnostic tools such as imaging or discogram to diagnose for DDD. A doctor will assess for nerve function via a flex hammer to deduce the reaction time or hot, cold, and touch stimuli. A definitive diagnosis is achieved through an MRI, CT scan, and X-ray to determine the alignments of the discs and spinal nerves. A definitive diagnosis is essential to distinguish DDD from other conditions such as tumors in the back.

Treatment.

Patients with DDD can use pharmacological or non-pharmacological approaches to manage their condition and relieve the symptoms. Patients can opt for mild exercise that strengthens and stabilize the degenerated discs to improve mobility. These exercises include yoga, cycling, walking, and swimming. Any weight lifting activity must be under a physician or chiropractor guidance. Surgery is an option for patients who fail to respond to pharmacological therapy within the first three months. It is best considered when the patient cannot walk, stand, or experiences numbness of legs. Surgery options include spinal fusion that stabilizes the spine and decompression, which relieves pressure by removing part of the inter-vertebral disc. Additionally, studies in Australia are underway for the effectiveness of stem therapy as a means for spinal disc regeneration. To alleviate pain, patients can take non-steroidal anti-inflammatory medications like naproxen, aspirin, and ibuprofen or pain relievers like paracetamol. Corticosteroid injection to the inter-vertebral disc space prevents inflammation that might potentiate DDD symptoms. If you have any back pain or a DDD patient that fails to respond to conventional therapy, worry no more. We can help, call now 205-637-1363.

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