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About Degenerative Disc Disease
Degeneration of the discs particularly in the moving sections of the spine (cervical and lumbar levels) is a natural process of aging. This dehydration or desiccation of the disc material reduces the flexibility and typically the height of the disc. In most patients the mere presence of degenerative discs is not a problem leading to pain, neurological compression, or other symptoms. However, in a certain number of patients, the disc degeneration leads to spinal "instability," the condition in which the spine is unable to bear the patient's weight or perform its normal functions without disabling pain. In these circumstances, treatments are available to try to reduce the patient's pain.
Symptoms: Cervical disc degenerative disorder can be characterized by neck pain. This neck pain can be most prevalent when the patient is upright or moving the head and can be reduced by lying down or reclining. Often the disc will be associated with osteophytes or bone spurs. They can further reduce movement and lead to nerve compression. The cervical nerve roots innervate the back of the head and neck as well as the arms and hands. If they are affected, the patient could have burning, tingling, numbness, and pain in these areas. Sometimes headaches result from cervical degenerative disc problems.
Lumbar disc degenerative disorder can be associated with low back pain. It would typically be a weight-bearing type of back pain with severe pain on sitting. Standing for any length of time and walking can also be painful, as are bending and lifting. Associated lumbar radiculopathy or nerve root pain can be characterized by burning, numbness, tingling, and pain running from the buttock and low back down the leg.
Diagnosis: Cervical and lumbar disc disorders if advanced enough are diagnosable on plain x-ray, which shows collapse or reduction in the height of the disc and possible osteophytes and bony end plate changes. A CT scan is helpful, but an MRI is most diagnostic for these conditions. The MRI shows the water content of the disc and best identifies the impingement on neurological structures. Changes in the bony end plates with increased water content in the bone are known as Modic changes.
In patients with multiple degenerative discs and associated pain, it is often difficult to distinguish which disc or discs are the pain generators. In this circumstance, additional, more invasive types of testing may be required. They could include discography/CT, a technique of injecting the discs with dye and taking a CT scan in which the patient identifies the quality and severity of the pain in each individual disc tested. Another option might be facet joint blocks, which are discussed below.
Treatment: There are different alternatives to surgery available for patients with degenerative disc disease and pain. Avoidance of painful behaviors including reclining or kneeling rather than sitting, not lifting in a bent position, and use of a corset brace are all options to try to reduce tensions and weight bearing by the affected lumbar disc. The cervical spine collar can achieve this goal. Patients who have degenerative discs in the lumbar spine can aid themselves by losing weight, building the back and stomach muscles through an exercise program, swimming, yoga and Pilates, and other core strengthening programs.
Pain management specialists and other trained physicians (e.g. physiatrists, neuroradiologists) can assist patients with more aggressive nonsurgical treatments. They can include facet joint injections in which the joints at the back of the spine adjacent to the bad discs can be injected with steroids and a local anesthetic to achieve pain relief. If these techniques are successful, sometimes patients will benefit more long term from facet rhizotomy. This technique can achieve lasting pain relief for a year or more by ablation of the sensory nerve through the facet joint.
Another nonsurgical treatment for degenerated lumbar discs is intradiscal electrothermal annuloplasty (IDET). This technique heats up discs proven to be painful by discography CT with a copper coil to a temperature that hardens the disc. It allows the disc to resist weight-bearing motion better than the degenerated disc in about 70% of patients.
The tried-and-true surgical technique for reduction or elimination of pain from degenerative discs is spinal fusion. It can be done from a posterior approach with screws and rods in the spine and adjacent bone graft or anteriorly with removal of the disc and placement of graph materials in the front. Sometimes surgeons will choose to place implants both in the disc and the screws from a posterior approach. With painful degenerative discs that cannot bear the patient's weight without severe pain, spinal fusion is highly successful in eliminating pain.
One of the long-term consequences of disc fusion can be accelerated degeneration of adjacent discs. That is, discs that are degenerating at levels above or below the fusion can be adversely affected, leading to more rapid degeneration of those discs than might have occurred without the adjacent fusion. In order to try to reduce that problem and to attempt to maintain more normal motion of the spine, artificial discs have been invented. At the present time, the artificial discs are placed from an anterior approach. In the cervical spine, this approach is standard, as if for a cervical disc excision. In the lumbar spine, it would require a retroperitoneal approach.
For more information about spine related conditions and treatments, visit the UCLA Spine Center at at spinecenter.ucla.edu.