No one wants to hear that they have a disease. And yet everyone will develop some degree of degenerative disc disease (DDD) — or degenerative spine disease — over the course of a lifetime. DDD refers to a combination of age-related and wear-and-tear-related changes that occur within the spine over time. It is very common and a natural part of aging.
Most people discover that they have DDD when symptoms appear. Based on the patient’s symptoms, medical history and physical exam, the doctor may order x-rays, CT or MRI scans. These test results are often a novel of complex and complicated terms that describe the various degenerative changes. As physicians, a key part of our job is to educate and help our patients learn what these terms and diagnoses mean. It is critical that those who suffer from this condition understand their spine health, how to best protect and keep their spine healthy, and how to effectively treat the symptoms they may be having.
What is DDD and what causes it?
To understand DDD, it is important to be familiar with the anatomy of the spine. The spine is made up of your neck (cervical spine), your mid-back (thoracic spine), and your low back (lumbar spine). The main components of the spine are the bones, or vertebrae, and between the vertebrae are the discs. Discs are made of cartilage and function as shock absorbers or pillow cushions between the bony vertebrae. As a result of age, wear and tear, and/or trauma, the cartilage of a disc can lose its water content. Inflammatory processes can also occur within the cartilage of a disc. When water content is lost, or there is inflammation in the joints, this imbalance causes pain. As a result of the disc having less elasticity, its ability to perform as a cushion or shock absorber is significantly reduced.
As the discs age and become worn, they are also at a higher risk of herniation. Herniation is when the outer covering of the disc (the annulus fibrosis) develops a hole — much like a pinhole in a water balloon — that enables a portion of the inner disc (the nucleus pulposis) to squirt out.
While the discs in between the vertebrae of the spine play a large function in the mobility of the spine, there are additional components of the spine that participate in spinal motion, mobility, and potentially disease. Facet joints between the vertebrae are located on the back of the spine and participate in the motion of the spine. These joints can also develop degenerative disease and arthritis, contributing to DDD. Ligaments are also present in the spine, and these can become injured or overgrown as well.
What does it mean for me?
One of the most challenging aspects of managing DDD is that it is present in so many people, regardless of whether they are having symptoms or not. As we age, we all have some degree of DDD. However, it’s only when symptoms develop that most people start paying more attention to it.
Degenerative disc disease can cause many different types of symptoms but the most common is back or neck pain. Degeneration of the discs can lead to abnormalities in spinal motion, which causes pain. When these abnormalities become severe, instability can develop. Nerve symptoms in the arms or legs may appear in addition to back or neck pain. Because of pressure on the nerves, a disc herniation or arthritis of the joints of the spine can cause symptoms of DDD. When nerves are compressed by degenerative disc disease DDD, symptoms can develop that radiate down the arms or legs, depending on where the nerve is pinched. This condition is called radiculopathy and can include shooting pain, numbness, tingling, and weakness in the muscles.
How do I prevent it?
Degenerative disc disease happens to all of us to some extent and is not totally avoidable. However, there are many things that we can do to minimize or slow down the progression of the process:
- Limiting the strain on the spine by strengthening the muscles around it. Building strong back, core, and abdominal muscles helps to take some of the wear and tear off the discs, joints, and ligaments.
- Practice healthy back movements by having good posture and avoiding severe bending or twisting movements. Lifting smart: using leg muscles instead of back muscles and not lifting things that are too heavy.
- Being an optimum weight decreases the wear-and-tear stresses on the back.
- Not smoking. Smoking increases the risk of osteoporosis, decreases blood flow to the spine, and decreases the body’s normal healing processes. These all lead to worsening of the degenerative process.
How do I treat it?
Much of the treatment of DDD focuses on slowing the progression once it is diagnosed and focusing on the preventative measures described above. The majority of treatments for DDD focus primarily on the symptoms, including the use of anti-inflammatory medications, targeted physical therapy and exercise, and occasionally pain medications to help with symptomatic relief. Alternative therapies such as acupuncture, massage, traction, and chiropractic treatment are other viable options for those who suffer from this condition.
When conservative measures fail, it’s time to see a specialist. A spine specialist can help explain all of the different treatment options, such as injections and possibly surgery. Surgery is usually reserved for patients with persistent, debilitating symptoms that are not relieved with conservative measures. In the vast majority of cases, surgery is not needed. There is heightened interest in discovering treatment options that will reverse the degenerative changes once they have begun. Many studies have looked at supplements such as glucosamine and chondroitin, as well as newer technologies such as platelet-rich plasma (PRP) and stem cells. To date, no definitive treatments have been proven in studies, but the good news is that ongoing medical research continues to advance our knowledge and understanding of this disease, thereby providing more safe and effective therapies and non-surgical options for managing DDD.
Joshua Wind is a neurosurgeon and director, Experts Educating Patients.
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