Degenerative disc disease is not actually a disease. It is a natural process by which the intervertebral discs of the spine change over time. As part of the normal aging process, our intervertebral discs, the cushions between the vertebrae (bones) begin to dry and shrink. Discs are made of a tough outer layer, called the annulus fibrosis, and a jelly-type centre, called the nucleus pulposus. These discs act as shock absorbers and enable us to perform movements such as bending and twisting. As we age, the discs begin to deteriorate, most commonly by drying out and shrinking. This reduces the disc’s flexibility and height. This deterioration can eventually lead to ruptured or herniated discs. This can then lead to instability in the spine, and/or narrowing of the spinal canal. Degenerative disc disease can occur anywhere in the spine but is most common in the lumbar and cervical spine.
The risk of degenerative disc disease increases with age. At birth, water makes up 80 percent of the discs. As we age, the discs in our spine lose water and elasticity and they don’t absorb shock and movement as well as they used to. Arthritis and osteoarthritis can also contribute to its onset by placing greater pressure on the discs, increasing the risk of a rupture. Risk factors for degenerative disc disease include age, obesity, lack of exercise, trauma, family history, osteoporosis, and smoking. Sudden, acute injuries such as a fall may cause the outer layer of the disc to tear or crack, causing it to bulge, rupture or fragment.
Symptoms of degenerative disc disease can include:
• Neck or back pain
• Radiating pain in the arms or legs
• Weakness or numbness in the arms or legs
• Pain made worse by bending, lifting or twisting.
• Pain made worse by sitting, as discs have three times more load while seated compared to standing
• Burning or tingling from the lower back and buttocks down through the legs
Some spinal degeneration occurs with normal aging and it does not always cause symptoms. The best way to prevent symptoms is to maintain a healthy, active lifestyle, perform weight-bearing exercises to maintain strong bones, and avoid smoking.
Your doctor will order one or more tests to investigate the degree of degenerative disc diease in your spine.
• Magnetic resonance imaging (MRI)
• Computerized axial tomography (CAT)
• Bone scan – SPECT CT
There are a number of treatment options that may provide relief for degenerative disc disease, and avoid the necessity of surgery. In some cases, surgery may be the only option after all other treatment options have been exhausted.
Regular exercise can help you build and maintain strength in the muscles of your arms and upper legs. This will improve your balance, ability to walk, bend and move about, as well as control pain. Swimming, Pilates and core strengthening exercises are excellent options.
Nonsteroidal anti-inflammatories (commonly called NSAIDS) may also relieve pain. In addition, your doctor may prescribe other medications to help with pain and/or muscle spasm.
Acupuncture may provide relief if symptoms are mild.
Steroid injections (corticosteroid injections)
Injections directly into the area around the spinal cord (known as epidural injections) may provide a good temporary and occasional permanent relief
Some patients with severe or worsening symptoms may need surgery. If you have problems with bowel or bladder function or problems with walking, then surgery will likely be recommended. Two common surgical options are:
• Laminectomy: This procedure involves removal of the bone, bone spurs, and ligaments that compress the nerves.
• Spinal fusion: In this procedure, two or more vertebrae are permanently fused together.
• Discectomy: involves removing the “bulging” disc material that is pushing on your nerve or spinal cord.