Overview
Degenerative disc disease (DDD) is a condition that occurs when your spinal disc deteriorates due to constant wear and tear. The spinal disc is a cushioning present between your vertebrae (bones within your spinal column) that acts as a shock absorber. When this protective cushion wears away, the bones rub against each other, causing pain. Degenerative disc disease commonly occurs due to aging, especially in people over 40. The most common symptoms associated with DDD are neck and/or back pain, weakness, and numbness that radiates down the leg. Treatment includes medications, physical therapy, special exercises, or surgery.
What is Degenerative Disc Disease?
Degenerative disc disease is when the disc within your spinal canal slowly loses its structure and functionality. The spinal discs help you move, bend and twist comfortably and protect the nerves that run down the spine between the vertebrae.
Initially, you may not have any symptoms, but as the extent of degeneration increases, you will likely experience neck and/or back pain, numbness, and tingling sensation in your hands or feet.
Stages of degenerative disc disease include:
- Stage 1: Dysfunction Stage
- In this stage, your spine loses its normal arch, which affects your posture. You are not likely to feel any pain.
- Stage 2: Dehydration Stage
- This stage exhibits increased postural changes and narrowing of the spinal canal.
- You may experience intermittent aches and pains along with tiredness.
- Stage 3: Stabilization Stage
- There is severe nerve compression seen, with radiating pain and increased tiredness.
- Stage 4: Collapsing Stage
- The degenerative changes are irreversible, with limited flexibility of the spine.
- There is severe nerve damage with an abnormal fusion of the bones.
What Are The Causes of Degenerative Disc Disease?
Your spinal disc comprises an outer tough wall (annulus fibrosus), and an inner soft core (nucleus pulposus). Degenerative changes occur as a normal part of your aging process, especially after the age of 40 years.
Causes
The increased wear and tear of the discs can cause degenerative disc disease in two ways:
- Loss of fluid
- The inner soft core of your disc contains water, which is eventually lost as you age.
- As a result, the disc gets thinner and does not provide as much shock absorption as before.
- Micro Tears or cracks
- Micro injuries, especially near your spinal nerves, can cause small cracks in your spinal disc.
- Most often, these microtears in the outer wall of your disc can lead to bulging of the disc, known as a herniated disc. This can compress your spinal nerve.
Risk factors
Certain risk factors can increase your incidence of developing degenerative disc diseases. These include:
- A history of injury (that may cause wear and tear due to high-impact injuries)
- Obesity (overweight)
- The presence of other medical conditions, including arthritis (inflammation of the joint)
- Physically demanding jobs or participation in high-impact sports (such as contact sports)
- Smoking and tobacco use (since it causes narrowing of the blood vessels that provide nutrition to your spine and related structures.
What Are The Symptoms of Degenerative Disc Disease?
The most classical symptom of degenerative disc disease is low-grade, continuous pain around the degenerating disc. This may be accompanied by occasional pain flare-ups that may last several days to a few weeks. Other common symptoms include:
- Increased pain with activities that involve bending or twisting the spine
- A feeling of “giving away” (which means your neck or back is unable to provide support) caused due to spinal instability
- Muscle spasms or muscle tension caused due to spinal instability can be extremely painful and debilitating (extreme pain that may eventually weaken the muscle)
- Possible sharp, stabbing radiating pain felt in the shoulder, arm or hand (cervical radiculopathy), or in hips, buttocks, or lower legs (lumbar radiculopathy)
- Increased pain during activities like prolonged sitting or standing (worsens back pain), or looking down at a book or phone (worsens neck pain)
- Reduced pain while changing positions frequently (like regular stretching of the neck can rescue neck pain)
- Decreased pain with certain positions (like using a pillow to maintain the curvature of your neck while sleeping)
How is Degenerative Disc Disease Diagnosed?
You must consult a neurologist ( a doctor specializing in the diseases affecting the brain, nerves, and spinal cord) if you experience severe neck or back pain that may radiate to your buttocks and lower legs.
Your doctor will record your medical history for the following:
- To rule out other medical conditions like diabetes (increased blood sugar levels), arthritis (inflammation of the joints), hypertension (high blood pressure), diseases related to the heart, lungs, or kidneys, and other blood disorders.
- To check for any history of previous surgeries or injuries that may have led to the wearing down of the spinal disc.
- To determine the medications being taken, including blood thinners, anti-inflammatory drugs, antidepressants, antihypertensive medications, or other herbal supplements.
Your doctor will conduct a physical examination to check:
- For any swelling or tenderness in the specific areas of your neck or back.
- Pain levels by pressing on the areas of complaint.
- Nerve function using a reflex hammer, where poor or no reaction could mean you have damaged or compressed nerves.
Additionally, your doctor may order the following diagnostic tests:
- Imaging scans such as CT (Computed Imaging) or MRI (Magnetic Resonance Imaging) to evaluate the state of the spinal nerves, discs, and their alignment.
- A discogram involves injecting a special dye into the disc's inner core. The dye will show up on a CT scan or X-ray.
- Electromyography checks the electrical activity of the nerve root to determine the cause of pain.
How is Degenerative Disc Disease Treated?
Treatment for degenerative disc disease depends on the stage of disc disease that you are suffering from. The goal is to ease pain and prevent further disc deterioration. Your doctor will suggest the best treatment option for you, based on your symptoms. Treatment may include:
Non-surgical treatment
- Hot and cold therapy
- Using hot pads and ice packs alternatively for 15 to 20 minutes up to 3 to 4 times per day can help ease pain and inflammation.
- Medications
- Painkillers and anti-inflammatory drugs can help ease pain and reduce swelling.
- Your doctor may also prescribe muscle relaxants to help relieve muscle spasms.
- Physical therapy
- Physical therapy can help reduce swelling through electric stimulation.
- Furthermore, your physical therapy exercises can help strengthen and stabilize the area around the affected disc and improve mobility.
- Exercises that help strengthen the muscles include walking, cycling, yoga, and swimming.
- Steroid injections
- Steroids are powerful medications that can help reduce swelling and inflammation.
Surgical treatment
Surgery is necessary if you do not respond to non-surgical methods for about 3 months. The following surgical options are available:
- Spinal fusion
- This procedure involves fusing (joining) two vertebrae together to prevent movement between them.
- During a spinal fusion, your doctor/surgeon will place bone or bone-like material in the space between two spinal bones that can fuse and heal as one bone.
- This helps ease the pain and restore the stability of the spine.
- Decompression surgery
Various surgical decompression options involve the removal of a part of the disc joint to relieve pressure on the nerves.
- Corpectomy: This procedure removes vertebrae or discs, fuses two bones together and heals over a period of time.
- Discectomy: A part of the spinal disc is removed to reduce the pressure exerted over the spinal nerve.
- Foraminotomy or Foraminectomy: In this surgery, your surgeon will expand the opening for the nerve root by removing bone or other tissue.
- Laminotomy or Laminectomy: Your surgeon will remove either a fragment or all of the bony arches on your spinal canal. This widens the spinal canal and relieves pressure.
- Osteophyte removal: Osteophytes are bone spurs (bony outgrowths) that are removed to relieve pressure.
How to Prevent Degenerative Disc Disease?
You cannot completely stop your spinal disc deterioration, but you can effectively slow down its progress and reduce pain through the following preventive measures.
- Living an active life
- An active lifestyle through regular exercise can improve your range of motion.
- Walking is an excellent workout that helps increase circulation and muscle endurance.
- Avoid or minimize over-twisting actions during your workouts.
- Improving your muscle balance and body mechanics
- Ensure you lift with proper body mechanics during weightlifting workouts to avoid stressing your spinal disc.
- Stop smoking
- Smoking increases the rate of desiccation (dehydration) and causes narrowing (constriction) of the blood vessels.
- Maintain a healthy body weight
- Carrying more weight on your body will increase the pressure or strain exerted, which may worsen the pain.
- Balance manual labor and avoid being sedentary (inactive)
- Maintain a balance in your activities since an inactive (sedentary) lifestyle can negatively affect your muscle strength to keep the pressure away from your spine.
- Whereas, on the other hand, overdoing or over-exerting yourself during a physically demanding job will make you more prone to wear and tear of the disc joint.
- Consume a healthy diet
- Consume foods rich in Vitamin D (fish, tuna, salmon, eggs) to maintain a healthy bone structure.
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