Degenerative Disc Disease

Causes of degenerative disc disease

As people age, the discs in the spine break down and could cause:

• Discs to lose their fluid — discs lose fluid that reduces their ability to act as a shock absorber. As the disc loses fluid, it can thin out, and this narrows the distance to the vertebrae of the spine.
• Disc rupture — the spongy material inside the discs may be pushed out through tiny cracks in the outer layer of the disc and could cause the disc to rupture.

Other causes of degenerative disc disease:

• Injuries to the back
• Repetitive motions form activities or sports

Risk factors for degenerative disc disease

• Weight — extra weight can add pressure to the back and put you at higher risk for degenerative disc disease.
• Smokers — smoking can break down the bones and discs and put you at higher risk for degenerative disc disease.
• Occupation — people who must lift heavy objects for their careers are at higher risk for degenerative disc disease.
• Repetitive activities — people who do repetitive activities, like weight lifters, are at higher risk for degenerative disc disease.

Symptoms of degenerative disc disease

Back and neck pain are the most common symptoms of degenerative disc disease. The severity of the pain associated with the condition varies from person to person. Where the pain is will depend on where the affected disc is located.

Symptoms of lumbar (lower back) degenerative disc disease include:

• Low-grade, continuous pain in the back, buttock or leg
• Pain that worsens with movements, such as bending over or twisting
• Pain that worsens when sitting
• Prolonged standing
• Numbness, weakness or tingling in the legs
• Trouble with coordination and balance
• Loss or bladder or bowel control

Symptoms of cervical (neck) degenerative disc disease include:

• Pain in the neck or arm
• Stiff neck
• Numbness or weakness that is radiated down through the shoulder to the arm and hand
• Difficulty moving the arms

Diagnosis of degenerative disc disease

Degenerative disc disease is diagnosed in a full physical exam, with a medical history and diagnostic imaging.

• Medical history — your doctor will determine what your symptoms are, when the pain started, when the pain is at its worst, previous injuries or conditions and activities that make the condition worse.
• Physical exam — your physician will test your range of motion and muscle strength, as well as look for other physical signs of degenerative disc disease in the neck, lower back or legs.
• Diagnostic imaging — an MRI scan can help to identify the location of the degenerative disc disease, as well as can rule out other conditions.

Treatments for degenerative disc disease

Most patients can relieve the symptoms associated with lumbar or cervical degenerative disc disease with nonsurgical treatments such as activity modification, exercise, physical therapy, anti-inflammatory medications and steroid medications.

Nonsurgical treatments for degenerative disc disease

• Activity modification — reduce the time doing the activity that causes pain associated with degenerative disc disease.
• Physical therapy and rehabilitation — physical therapy is a crucial treatment for degenerative disc disease and research has shown that exercise and movement during the recovery process is critical to facilitate healing.
• Medications — medications, such as NSAIDs, oral steroids, muscle relaxants and narcotics, can alleviate the pain associated with degenerative disc disease.
• Epidural injections — an injection into the spine that relieves back or neck pain by reducing the inflammation.
• Ultrasound — an ultrasound could warm the area, which can make blood flow return to the injured area.

Surgical treatments for degenerative disc disease

Surgery is suggested if the patient has continuous pain for six months and nonsurgical treatments have not been effective.

Surgical treatments for lumbar or cervical disc degeneration include:

Lumbar spinal fusion
A lumbar spinal fusion places small pieces of the bone in front of the spine or in the back of the spine so the bone will grow together and fuse the spine together. The goal of spinal fusion is to decrease back pain by eliminating the motion in the fused part of the spine. It is important to understand that the spine is not fused together during the procedure but the surgery creates the conditions so that the spine can fuse together over three to six months.

Anterior cervical discectomy and fusion (ACDF)
An anterior cervical discectomy and fusion is a surgical technique that is performed through small incisions on the front of the neck. Your Mercy Health surgeon will remove the affected disc and stabilize the vertebrae around the impacted area. The goal of an ACDF surgery is to alleviate the symptoms of degenerative disc disease.

Discectomy
When a bulging or herniated disc is pressing on the nerves, your spinal surgeon may go into the affected area and remove all or part of the disc. There are minimally invasive techniques to remove the disc. Minimally invasive techniques are preferred due to the shorter recovery time.

Corpectomy
A corpectomy is performed when the spinal surgeon needs to remove the entire vertebral body because disc material has lodged itself between the vertebral body and the spinal cord.

Surgical decompression
Surgical decompression procedures remove the tissue that is irritating the nerves. Surgical decompression options include:

• Facetectomy — the facet joint is removed to reduce the pressure put on the nerves.
• Foraminotomy — the foramen opening is made larger so that the nerve can leave the vertebra without being squeezed; performed when a bone spur is pressing on the nerve as it leaves the vertebra (through the foramen).
• Laminectomy — the lamina, that protects the spinal canal and spinal cord, is removed partially or fully to make more room for the spinal cord and relieve pressure on the spinal cord.
• Laminotomy — a larger opening is created in the lamina, the bony plate that protects the spinal canal and cord; typically performed if the lamina is pressing on the nerves in the spine.

Lumbar artificial disc replacement surgery
A lumbar artificial disc replacement surgery is a new surgical option for degenerative disc disease that helps you maintain mobility. The spinal surgeon will remove the damaged disc (in a discectomy) and replace with an artificial disc. The artificial disc may be able to keep the spine flexible and eliminate pain.

Recovery from degenerative disc disease

If you have had surgery for degenerative disc disease, the recovery process is lengthy. Although the incisions heal within a couple weeks, spinal fusions take months to heal properly. You may be restricted from driving for two weeks or more and may not be able to return to work for two to six weeks.

It is important to work with your doctor and physical therapists and follow their instructions on when you can resume your everyday activities.