What is Degenerative Disc Disease?
Degenerative disc disease is one of the most common causes of neck and back pain. Discs are the cushion that acts as a shock absorber for the spine. A disc is made up of a soft inner core (nucleus pulposus) and outer fibrous cover (annulus fibrosus). Over time these discs can have wear and tear. The nucleus pulposus can flatten out and compress the spinal vertebrae together. The annulus fibrosus can thin and weaken and the inner nucleus pulposus can protrude and press on nerves of the spinal cord. This can cause either a sharp pain or dull and chronic discomfort and usually and worsens with activity. You may have numbness or tingling or even weakness of muscles as well. Degenerative disc disease can progress to include a herniated disc, pinched nerve, slipped disc, ruptured disc, disc protrusion and torn disc.
Degenerative disc disease is progressive over many years and may not have any symptoms for a long time. If the disc is in the lower back (thoracic and sacral spine) then you may have pain, weakness and numbness extending from your back to your buttocks, thighs, and down to your calves. If the disc is in your neck (cervical spine) then you may have the same symptoms in the neck and arms. You may have aching, tingling or burning sensations in the affected area. The pain is usually only on one side of the body but may be both. Movement, walking sitting and certain bending or twisting movements may worsen the pain. When you are unable to perform your normal daily activities then it is time to see your doctor.
Wear and tear over many years can cause the nucleus pulposus to dehydrate and flatten which can cause the vertebrae to rub together. The outer annulus fibrosus can wear and thin and allow the nucleus pulposus to protrude through the outer ring which can press on the sensory or motor nerves of the spinal cord causing symptoms. Heavy lifting, repetitive motions or turning and twisting can also cause sudden injury in a degenerative disc. Many times there is a sudden sharp pain in the spine area with resultant dull pain in the area of the nerve. Other factors that can predispose you to degenerative disc disease are having a few extra pounds, lack of exercise and weak muscles.
Your doctor will take a complete history which may when or how your injury occurred. A physical exam will evaluate you for your source of your pain and discomfort. Your nerve function will be evaluated along with and muscle strength and skin sensation. Imaging tests can help your doctor identify injured areas of spinal bones and muscles. X-rays may be used to look for fractures or tumors and the bony anatomy.
Studies that may be used for diagnosis include a computed axial tomography (CAT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it. A magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the spine, discs, spinal cord and spinal nerves. Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted. An electromyogram uses needle electrodes to look for muscle damage.
Degenerative disc disease is a chronic condition that tends to worsen over time. Conservative treatment for acute injuries can decrease symptoms. Resting can allow your back to heal. Ice or heat in the area of discomfort may help you feel better. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. If pain lasts more than 10 days you should talk to your doctor as the side-effects of long term NSAID use rarely include stomach ulcers, circulation problems and heart failure. Muscle relaxants and nerve pain medications can also be used. Stretching and exercises may help improve the symptoms of a herniated disc. A physical therapist can show you which exercises you should perform.
Surgery may be needed if you have a sudden severe bulging disc from degenerative disc disease to prevent nerve damage or if conservative treatments do not relief pain after at least 3 months of therapy. Surgery will also relieve pain much more rapidly than rest and medication. You may require one or a combination of the following procedures.
- Laminectomy or laminotomy– your surgeon uses a microscope to make a small opening in the spinal bone (vertebral arch) to relieve pressure on the nerve roots.
- Discectomy or microdiscectomy– the most common bulging disc surgery in the lumbar region involves removing all or a portion of the bulging disc that is pressing on your nerve root. A microdiscectomy uses smaller instruments which are less invasive and can be an outpatient procedure.
- Artificial disc surgery– is used when only a single disc in the lower back is involved and you do not have widespread arthritis or osteoporosis. An abdominal incision is used to approach the spine and an artificial disc replaces the bulging disc. This requires general anesthesia and generally a short hospital stay.
- Spinal fusion– two of more of the spinal vertebrae are permanently attached together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments. This also requires general anesthesia and a short hospital stay.
The best way to manage your degenerative disc disease is to educate yourself as much as you can regarding your condition, and to become involved in your own care and treatment with your healthcare providers. Keeping your neck as healthy as possible includes having a healthy weight, good posture, proper lifting techniques, and regular exercise.
The Neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of degenerative disc disease. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).