Degenerative disc disease or DDD in short, is normally related to the process of aging. As one ages, spinal disc, like other joints, can collapse & become problematical. This is a usual process of growing older as our body has to deal with years of stress, strain & overuse. However, DDD may also occur at tender ages of 20 years & youth cannot always save one from this spinal condition. Many patients also inherit a prematurely aging spine. Intervertebral discs which act as pillow-like cushions between vertebrae are affected by this condition. Ability to carry weight & complex movements of spine & maintaining back stability are noticeably lost. Discs lose elasticity, flexibility & shock absorbing characteristics with the age factor & thereby result in harsh back pain. According to reports, about 60 percent of patients above 50 years of age are affected by degenerative disc disease worldwide.
What is Degenerative Disc Disease?
Degenerative Disc Disease is basically a term which is used to explain normal aging changes within spinal discs. It is not a disease in the real sense, but rather a condition in which patient’s discs degenerate or lose elasticity & height to support & cushion spine. Discs in this condition do not get rich supply of blood, so once these discs are injured they cannot repair themselves easily. These age-related changes may eventually develop the following conditions.
- Spinal Stenosis – This condition causes narrowing of open space within spine which holds the spinal cord
- Herniated Discs – This condition implies an abnormal bulge of spinal disc
- Osteoarthritis – This condition results in breakdown of cartilage tissue which supports & cushions bone joints
These undesirable spine conditions create pressure on spinal cord & nerves & eventually lead to severe back or neck pain.
Deterioration of spinal discs results in degenerative disc disease. Age-related changes in spinal discs include the following.
- Loss of Fluid – Loss of fluid in discs diminishes the shock absorbing capacity & makes them less flexible. Discs become thin & distance between the vertebrae narrow.
- Cracks in Capsule – Small tears or cracks appear in capsule or simply in the outer layer of the disc. A Jellylike material known as a nucleus within the disc may move out through these cracks or tears causing the disc to bulge & rupture.
- Smoking – Patients who smoke cigarettes are more prone to develop this condition of degenerative disc disease.
- Heavy Lifting – Patients who perform heavy physical work like lifting loads suffer from this condition of degenerative disc disease.
- Obesity – Patients who are obese are more likely to develop degenerative disc disease.
- Acute Injury – Acute injury from suddenly falling may also begin the degeneration process in many patients.
- Bone Spurs – They can put pressure on the spinal cord or spinal nerve roots resulting in serious pain & disturbing nerve function.
There are various signs & symptoms that are fairly consistent for patients with neck pain or lower back pain from degenerative disc disease.
- Pain from Physical Activity – Pain which is usually associated with physical activity & will burst out at times but then go back to normal pain levels or go away completely.
- High Level of Irritation – Amount of neck & back pain is quite variable between patients & can range from almost no pain to high level of irritation, eventually leading to harsh pain.
- Disabling Pain – Extreme chronic pain that is fully disabling caused from degenerative disc disease may occur in some cases, but is rarely seen.
- Routine Activities – Activities which involve lifting, bending & twisting worsens the pain of patients. Running or merely walking may provide relief than prolonged standing or sitting.
Patients with degenerative disc disease will generally find relief in a reclining posture or rest down with a pillow since these positions relieve stress on the spinal disc space.
It can be a challenge to diagnose degenerative disc disease as it develops so gradually & can have relative problems like herniated disc, spinal stenosis etc. For example, spine surgeons may be able to quickly identify herniated disc, but it is difficult to diagnose that this is a herniated disc caused by degenerative disc disease. To correctly diagnose this condition, spine surgeons will ask patients about their current symptoms & will evaluate complete health. Along with this, surgeons will conduct a neurological examination, to check for reflexes, changes in nerve, muscle strength & severity of pain. Surgeons may order the following imaging tests to confirm the cause of pain.
- X-Ray Test – Surgeons may recommend an x-ray test, to see bones in patient’s spine. X-rays are highly effective at showing fractures, narrowed spinal channels, bone spurs or osteoarthritis.
- CT scan or MRI – Computerized tomography scan or a magnetic resonance imaging scan may be needed in order to diagnose degenerative disc disease. These tests are clearly able to show the delicate tissues in patient’s spine & can help in identifying issues such as herniated disc or bulging discs.
- EMG – When spine surgeons suspect the condition of severe nerve damage from degenerative changes in patient’s spine, they may order a special test known as an electromyography to observe response of nerves.
- Bone Scan – Surgeons may recommend bone scan test to detect spinal issues such as fractures, osteoarthritis or infections related to degenerative disc disease.
- Myelogram – Surgeons might recommend a myelogram in order to know if patient is having spinal cord disorders like nerve compression causing extreme weakness or pain.
Treatments Options for Degenerative Disc Disease
Spinal disc degeneration cannot be reverted, but proper lifestyle, exercise & careful management of neck & back pain can contribute to better quality of life. When traditional methods & therapies have failed to help patients, spine surgeons may recommend surgery. However, nonsurgical treatment methods may prove equally effective in certain cases.
- Nonsurgical Treatments
Nonsurgical treatments for degenerative disc may include self-care, pain medications, exercises, rest, physical therapy, pain management & chiropractic.
- Self-Care – Maintaining good posture & keeping the spine in proper alignment are most essential things for patients suffering from disc degeneration disease. Patients may be required to make several adjustments to daily sitting, standing & sleeping habits as well. Patients should learn proper ways to bend & lift in order to calm down back & neck pain.
- Stress – Stress is a major obstacle in controlling pain. Pain tends to increase when patients are stressed or tense. Relaxation techniques like deep breathing & exercises are the best way of restoring body control.
- Physical Therapy – Main aim of physical therapy is to help patients return to normal daily activities as early as possible. Exercise is extremely helpful in treating a painful degenerative disc & it also provides faster recovery.
- Chiropractic – Chiropractic manipulation is a basic treatment that chiropractors use for patients with neck or back pain. Chiropractors carefully apply pressure to the affected portion which is stiff or immobile.
- Medications – Spine surgeons may prescribe pain relievers, nonsteroidal anti-inflammatory medicines or steroids to patients. Aspirin, naproxen (Naprosyn, Aleve), celecoxib (Celebrex), ibuprofen (Motrin, Nuprin, Advil) are some of the nonsteroidal anti-inflammatory medications used to minimize inflammation & alleviate pain. In some cases, muscle relaxers are also recommended by doctors for muscle spasms.
- Holistic Therapy – Some patients find yoga, acupressure, acupuncture, nutrition, meditation, diet changes & biofeedback to be beneficial in managing neck & back pain as well as improving health status.
There are various steps involved in preparing patients for the upcoming spinal surgery for treating degenerative disc disease. Before proceeding for any type of spinal surgery, it is vitally essential for patients to understand the surgery & surgeon’s expectations.
- Medications – Patients will need to stop taking any non-steroidal anti-inflammatory medications seven to ten days prior to spinal surgery. These medications are responsible for thinning the blood which might cause bleeding during surgery. Common medications of this type include Celebrex, Ibuprofen, Naprosyn, Advil, Aleve, Voltaren, Diclofenac, Motrin, Mobic & Indocin.
- Discontinue Smoking – Most surgeons will strongly recommend complete smoking cessation prior to any type of spine surgery. Various studies have proved that nicotine interferes with muscle, skin & healing of bone. Smoking increases post-operative infection rates & other complications as well.
- Medical Doctor – Spine surgeons may ask patients to visit their medical doctor before surgery to obtain clearance on good health. It is necessary to evaluate the medical status of patients prior to any spine surgery in order to ensure that they are healthy enough to safely undergo surgery.
Patients with disc degeneration condition may ask questions from the following list to get a comprehensive idea about the treatment plan.
- What is degenerative disc disease?
- What is my current health status?
- Why is this surgical procedure being recommended to me?
- Are there any alternatives to this type of surgical treatment?
- What are the major benefits of this procedure in terms of mobility & pain relief?
- How long will the outcome last?
- What are the risks involved with this recommended treatment?
- Will I have back or neck pain following this procedure?
- What pain control medications will I be given?
- How much time will it take for complete recovery?
- Are there any limitations during recovery phase?
- When can I return back to my job?
Surgery for treating degenerative disc disease is rarely recommended unless patients have a disc herniation problem, instability & symptoms have not improved with nonsurgical methods.
- Spinal Fusion Surgery – Degenerative disc disease may be treated with spinal fusion surgery. Spinal fusion surgery is utilized to fuse or join two or more vertebrae mostly in the lower back region. This is a major surgery which normally lasts several hours. It employs different methods of spinal fusion depending upon the individual medical condition of the patient. In some cases, bone is taken from pelvic bone or a bone bank & which is used to make bridges between vertebrae next to each other. This bone graft is meant to help the new bone grow. Sometimes, metal implants are used to hold vertebrae together for as long as it takes for the new bone to grow between them.
- Motion Preservation Surgery – Basic role of spine surgery with Instrumentation & stabilization is to provide additional spinal stability while setting up an environment for fusion. Various types of medical instrumentation devices have been developed to aid successful spinal fusion as bones tend to fuse effectively in a stabilized atmosphere with little motion. Instrumentation is a type of implanted medical device which helps fusion set-up by limiting motion at the fused segment. Usually made of titanium or stainless steel, instrumentation devices typically come in many shapes & sizes to suit specific set-ups.
Patients should ask spine surgeons regarding specific recovery plan following spine surgery. Following the instructions of surgeons will aid faster recovery & increase chances of successful outcomes. Healing from low back pain & spine surgery is an ongoing procedure. How fast one will heal largely depends upon the kind of spine surgery patients have undergone, their commitment to precisely follow physical therapists’ instructions & to exercise properly as suggested by the spine surgeon. Spine surgeons will schedule follow-up sessions post-surgery to check on how patients are recovering & conclude if anything else needs to be done.
Risks & Complications Associated with Surgery for Degenerative Disc Disease
Generally, spinal fusion surgery is performed for treating severe pain of disc degeneration. As is seen in major surgical procedures this surgery also faces certain risks as given below.
- Blood clot
- Internal bleeding (hemorrhage)
- Pain at surgical site
With spinal fusion surgery, patients may also face certain uncommonly seen complications as listed below.
- Shifting of implant
- Misaligned fusion
- Vertebral fracture when fixing implant
- Implant collapse into bone (subsidence)
- Implant damage after several years
Patients should discuss with spine surgeons as to how they can maintain a healthy lifestyle after spine surgery. Eating a healthy diet & exercising are extremely important. Quite often, outcomes following spine surgery are more than just a drop in neck & back pain. Patients may however also observe the following benefits post-surgery.
- More physically fit
- Mood improvement
- They don’t need to take as much pain medications
- They can move around better
- They can return back to work
- Increased productivity at work due to lesser pain
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