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 Degenerative disc
Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ
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Overview
Degenerative disc disease commonly occurs with age as discs become more
brittle, less resilient and more prone to herniation. Degenerative
disc disease is the single most common diagnosis related to serious
back and neck pain. When a disc herniates in the spine, the surgeon
can sometimes simply remove a portion of the disc. In other cases,
where the disc is more damaged and must be removed, something must
be placed into the disc space. Otherwise, the two vertebrae will collapse
on top of one another, placing pressure on the nerve roots that branch
off from the spinal cord.
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Causes
Some of the contributing factors of degenerative disc disease are family
history, lifestyle and age. The prime age for disc-related problems
is after 35. If a parent had back or neck surgery for a herniated disc,
you should be particularly concerned about taking care of your back.
Lifestyle is another important factor. Those who perform frequent lifting
or put themselves in situations where the spine is exposed to trauma
or repetitive shock can also develop degenerative discs over time.
Osteoporosis can lead to disc degeneration. As bones weaken,
a person becomes increasingly at risk for vertebral fractures.
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Symptoms
Degenerative disc disease makes the back more prone
to injury and can contribute to the following conditions:
- Back pain
- Neck pain
- Hunched over appearance
- Herniated disc
- Vertebral fractures
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Diagnosis
Outlined below are some of the diagnostic tools that your physician may
use to gain insight into your condition and determine the best treatment
plan.
- Medical history: Conducting a detailed
medical history helps the doctor better understand the possible causes
of your back and neck pain, which can help outline the most appropriate
treatment.
- Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
- X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are of
limited value, however, since they do not show muscles and ligaments.
- MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
- CT scan/myelogram: A CT scan is similar to an MRI in
that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A local
anesthetic is injected into the low back to numb the area. A lumbar
puncture (spinal tap) is then performed. A dye is injected into the
spinal canal to reveal where problems lie.
- Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup. These
tests, called electromyography (EMG) or somatosensory evoked potentials
(SSEP), assist your doctor in understanding how your nerves or spinal
cord are affected by your condition.
- Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton. Bone
scans are also used for finding lesions for biopsy or excision.
- Discography - Discography is used to determine the internal
structure of your disc. It is performed with a local anesthetic by injecting
dye into the disc under X-ray guidance. An X-ray or CT scan is performed
to determine if the disc’s structure is normal or abnormal and
if the injection causes pain. A benefit of a discogram is that it enables
the spine surgeon to determine the disc level that is causing pain.
And if surgery is necessary, discography helps ensure a successful surgery and reduces the risk
of operating on the wrong disc.
- Injections - These can act as a
bridge to physical therapy by relieving back pain and providing the
physician with important information about your problem.
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Treatment
 A typical solution for problems related to DDD is a spinal
fusion procedure, or artificial
disc implantation.
Dietary supplements or medications may be recommended to
treat degenerative disc disease that is linked to osteoporosis.
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FAQ
What is degenerative disc disease?
A natural byproduct of aging is the loss of resiliency in spinal discs
and a greater tendency for them to herniate, especially when placed under
a weighty load, like when we lift heavy objects. Additionally, some people
have a family history of degenerative disc disease, which increases their
own risk of developing it. When a natural disc herniates or becomes badly
degenerated, it loses its shock-absorbing ability, which can narrow the
space between vertebrae.
Who is a candidate for an artificial
disc?
Patients with a diseased disc between L4 and L5 or between L5 and S1
(all in the lower back) that is worn out or has become injured and causes
back pain are candidates for an artificial disc. Other candidates include
those with degenerative disc disease (DDD) whose vertebrae have
moved less than 3mm. Your physician will help you determine whether or
not an artificial disc is a good choice for you. Factors that will be
considered include your activity level, weight, occupation and allergies.
What are the benefits of an artificial
disc?
Generally speaking, those who receive artificial disc replacements return
to activity sooner than traditional fusion patients. Also, because there
is no need to harvest bone from the patient’s hip, there is no
discomfort or recovery associated with a second incision site. Some of
the overall benefits of artificial disc surgery include:
- Retains movement and stability of the spine
- Prevents degeneration of surrounding segments
- No bone graft required
- Quicker recovery and return to work
- Less invasive and painful than a fusion
- Reduces pain associated with disc disease
While the artificial disc may well be a promising new technology,
most spine surgeons today are very cautious. There are many serious
concerns including:
- Constantly changing technology as new discs are coming
out that last longer and may be easier to insert and remove.
- The life span of the implants are in question.
- What happens if the implant needs to be removed?
Consult with your spine surgeon to determine your best
option. Click here to
learn more about the artificial disc.
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Cristian Jaliu, M.D.
John V Cuff, M.D.
Kimberly P. Walpert, M.D. 
Bryan B. Barnes, M.D.
Ted Jacobs, M.D.
Harlan Bruner, M.D.
