Unfortunately, degenerative disc disease (DDD) affects us all. It is a natural process of aging similar to arthritis. Degeneration affects the discs in the spine. The process of degeneration typically begins in your teens so in general, everybody has some type of degenerative disc disease even if you have no back pain. Certain things can make your discs degenerate faster. Genetics plays an important role but the number one preventable risk factor is smoking. This can increase the rate of degeneration by 3-4 times more than that of a nonsmoker.
Think of the discs in your spine as shock absorbers. They connect the vertebral bodies (bones in your back) in your spine and cushion the impact between the bones when you walk, run, jump and during all your daily activities. The discs are essentially fluid-filled structures; the more fluid in the disc, the better the cushion in your spine. Degeneration is the process of losing fluid in your discs. As the disc loses fluid, the disc decreases in height which can be a cause of spinal pain. In some cases as the disc “dries”, it can crack very similar to mud when it dries. This crack, also known as a tear, can be a source of pain when the fluid inside of the disc leaks out of the crack and irritates the surrounding nerves in the disc and the spine. This can occur over time but can also happen acutely. Degeneration can be seen by X-rays but more precisely by MRIs.
Degeneration can lead to disc bulging, disc protrusions and even disc herniations. Please keep in mind, however, that just because you have been diagnosed with one of the above conditions, does NOT mean that it is the cause of your pain. To support this fact, John Hopkins University did a study. It offered “free” MRIs of the low back to 100 middle-aged people who had NO pain. Almost 70% of these individuals had an abnormal finding. This proves that the most important part of finding the cause of your pain does not come from any study but comes from being evaluated specifically by a spine specialist. Remember, a study is only as good as how it supports your symptoms. Here, at VIPSC, we treat people not MRIs.
Degenerative disc disease is the number one cause of mechanical low back pain and the number two cause of mechanical neck pain. However, as was mentioned earlier, everyone has some sort of DDD even if they have no pain. So, how do you know if your DDD is the cause of your pain? An evaluation by one of our spinal specialists is the key. There are many causes to spinal pain and in order for you to get the best treatment for the specific pain you have, having an accurate diagnosis is a must.
Your spine is a very complex structure. In most cases, there is more than one potential cause for your pain. Often times, this may require undergoing specific minimally invasive procedures on certain muscles, joints and/or nerves in your spine to truly know where your pain is coming from. If your pain improves, then this serves as a diagnosis of your pain.
So how do we treat DDD? This is a difficult question to answer as it, once again, depends on your symptoms. If your pain is only in your back and does not travel past your knee(s), then it is important to determine if the disc(s) are truly your pain generators. You may be recommended to undergo a lumbar discogram to specifically determine if one or more of the discs are causing your pain. Unfortunately, even if you have a degenerated disc that is the cause of your pain, the treatment options for your disc problem are not very good. Initially, physical therapy is recommended. Therapists can show you how to strengthen your spine. They can also help to decrease some of your muscle tension which can also contribute to your pain and show you what you need to do on your own to maintain a healthy spine. This can be in conjunction with medications such as anti-inflammatories and muscle relaxants. If your pain continues for more than several weeks, you may need to undergo steroid injections. In particular, epidural steroid injections (lumbar, thoracic, cervical) can help to specifically decrease the inflammation in your spine at the level of your degeneration. Typically, a series of 2 or 3 are given. At times, it may take all 3 injections to gain some relief. Surgery may be an option for this condition which can involve placing screws and rods in your spine to fuse the degenerated level(s) in your spine. This, however, can lead to increased degeneration in the discs above and below the level of the fusion. When a disc is fused ie “retired”, the remaining discs in your spine have to work even harder as the work load stays the same. This tires the remaining discs faster, leading to faster degeneration. More recently, the degenerated discs can be replaced but outcomes for this surgery are still inconclusive with results seemingly similar to spinal fusion. Overall, most treatment options including surgery do not offer more than a 50% chance of improvement with always the risks of worsening your pain. If treatment options fail to improve your pain and surgery is not indicated and/or not an option for you, implantable device therapies (i.e. spinal cord stimulation and implantable drug infusion therapy) have the potential to decrease your pain by 50% and increase your functioning level without the reliance on chronic daily oral medication usage which can adversely affect your kidneys and liver long term.