Degenerative Disk Disorder

Degenerative disc disorders are one of the most common reasons for low back and neck pain, and also one of the most misunderstood.

Simply put, degenerative disc disease refers to symptoms of back or neck pain caused by wear-and-tear on a spinal disc. In some cases, degenerative disc disease also causes weakness, numbness, and hot, shooting pains in the arms or legs (radicular pain). Degenerative disc disease typically consists of low-level chronic pain with intermittent episodes of more severe illness.

Lumbar Degenerative Disc Disease
Degenerative disc disorder in the lumbar spine can produce pain in the lower back, legs, and hips.

Discomfortable disc degeneration is prevalent in the neck (cervical spine) and lower back (lumbar spine). These regions of the spine experience the most movement and stress and are most susceptive to disc degeneration.

The term degenerative reasonably suggests that symptoms will get severer with age. Although, the word does not pertain to the signs but instead describes the process of the disc degenerating over time.

Despite what the name implies, degenerative disc disease is not a disease, but a condition in which ordinary, age-related wear-and-tear on a disc produces instability, pain, mobility challenges, and other signs and symptoms. This condition usually does not end in long-term disability, and the majority of cases can be handled using non-surgical treatment techniques.

Although it is accurate that disc degeneration tends to progress over time, the discomfort and pain from degenerative disc disease ordinarily do not worsen. In fact, the pain typically subsides, and you feel better if given enough time. The degenerative cascade theory explains how this process works.

Disc degeneration is a consistent and characteristic element of aging, and over time everybody will present some changes in their discs. However, a degenerating disc does not always cause symptoms to develop. In fact, degenerative disc disease is quite variable in its nature and severity.

We provide in-depth information about aspects of degenerative disc disease based on commonly accepted principles, such as how a degenerated disc causes pain and joint symptoms and treatments.

Medical Practitioners Disagree
There is little agreement in the medical research community of elements does and does not establish the diagnosis of degenerative disc disorder. This lack of consensus may be due to the condition’s characteristics of causing symptoms off and on over the time span of numerous years, causing it to be difficult for doctors to track symptoms.

It is imperative to note that disc degeneration can lead to or hasten the onset of additional spinal conditions, such as:

Spinal stenosis, a form of spinal degeneration that leads to nerve root or spinal cord pinching.

Osteoarthritis in the spine in the spine, adjust in the facet joints at the back of the spine that transpire as an outcome of degeneration.

Spondylolisthesis, in which one vertebral body slips forward on another due to facet joint degeneration.

Scoliosis, where discs degenerate in an irregular (lopsided) fashion and a ‘curve’ can form over time.
A degenerating spinal disc does not always lead to pain or other symptoms. Because the disc itself has very little innervation, pain usually occurs when the degenerating disc affects other structures in the spine (such as muscles, joint, or nerve roots).

Pain associated with degenerative disc disease generally stems from two main factors:

  1. Inflammation. Inflammatory proteins from the disc space interior can leak out as the disc degenerates, causing swelling in the surrounding spinal structures. This inflammation can produce muscle tension, muscle spasms, and local tenderness in the back or neck. If a nerve root becomes inflamed, pain and numbness may radiate into the arm and shoulder (called cervical radiculopathy in cases of cervical disc degeneration), or into the hips or leg (called lumbar radiculopathy, in cases of lumbar disc degeneration).
  2. Abnormal micro-motion instability. The cushioning and support a disc typically provides decreases as the disc’s outer layer (the annulus fibrosis) degenerates, leading to small, unnatural motions between vertebrae. These micro-motions can cause tension and irritation in the surrounding muscles, joints, and nerve roots as the spinal segment to become progressively more unstable, causing intermittent episodes of more intense pain.
  3. Both inflammation and micro-motion instability can cause lower back or neck muscle spasms. The muscle spasm is the body’s attempt to stabilize the spine. Muscle tension and spasms can be quite painful and are thought to cause the flare-ups of intense pain associated with degenerative disc disease.
  4. Degenerative disc disease primarily concerns a spinal disc, but will most likely impact other parts of the spine as well. The two findings most correlated with a painful disc are:
  5. Cartilaginous Endplate Erosion. Like other joints in the body, each vertebral segment is a joint that has cartilage in it. In between a spinal disc and each vertebral body is a layer of cartilage known as the endplate. The endplate sandwiches the spinal disc and acts as a gatekeeper for oxygen and nutrients entering and leaving the disc. As the disc wears down and the endplate begins to erode, this flow of nutrition is compromised, which can hasten disc degeneration. As the disc goes through this process, the disc space will collapse.

Disc space collapse. As a disc degenerates, the disc space will collapse, placing undue strain on the surrounding muscles as they support the spine and shortening the space between vertebrae, leading to additional micro-motion and spinal instability.

These processes typically progress gradually rather than all at once. Endplate erosion and disc space collapse can add to spinal instability, tension in the surrounding muscles, and both local and nerve root pain.

Degenerative disc disease often happens in the cervical spine (neck) or the lumbar spine (lower back), as these regions of the spine experience the most motion and are most susceptive to being worn down.

Cervical Degenerative Disc Disorder Pain
Potential symptoms of cervical degenerative disc disorder comprise of spreading pain in the shoulders, hands, and arms.

The most characteristic symptom of degenerative disc disorder is a low-grade, chronic pain around the degenerating disc that irregularly flares up into more critical, possibly disabling pain.

Pain flare-ups can be linked to prior movement and unusual strain on the spine, or they may appear abruptly for no apparent reason. Episodes can continue between a few days to several weeks before returning to low levels of pain or temporarily go away entirely.

Other prevalent symptoms of degenerative disc disease encompass:

  • Heightened pain with exercises and activities that include bending or rotating the spine, as well as lifting something heavy.
  • A “giving out” sensation, produced by spinal imbalance, in which the neck or back feels as if it is not possible to give essential support, and may lock up and make movement feel seemingly impossible.
  • Muscle tension or muscle spasms or muscle tension, which are well-known consequences of spinal instability. In some cases, a degenerated disc may cause no pain, but muscle spasms are severely painful and momentarily debilitating.
  • Potential radiating pain that seems stabbing, sharp, or hot, In instances of cervical disc degeneration, this pain is sensed in the shoulder, arm, or palm (referred to as a cervical radiculopathy); in cases of lumbar disc degeneration, discomfort is felt in the buttocks, hips, or down the back of the leg (referred to as lumbar radiculopathy).
  • Heightened pain when maintaining certain positions, such as sitting or standing for extended periods (exacerbating low back pain), or looking down too long at a cell phone or book (worsening neck pain).
  • Decreased pain when switching positions commonly, rather than standing or staying seated for prolonged periods. Furthermore, steadily stretching the neck can lower cervical disc pain, and exercising short, frequent walks throughout the day can lower lumbar disc pain.
  • Lower pain with specific positions, such as using a pillow that secures the neck’s natural curvature during sleep, sitting in a laid-back or reclining position or lying down with a pillow underneath the knees.
  • The amount of chronic pain— described as the baseline pain—is considerably different between individuals and can extend from almost no pain or just a numbing /throbbing level of soreness to severe and disabling pain.
  • Continuous or chronic pain from degenerative disc disease that is severe and completely disabling does happen in some cases but is relatively uncommon.

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The following process is generally practiced to diagnose degenerative disc disease:

A medical history is obtained that details existing and past symptoms of neck or back pain, encompassing when the pain began, how often pain flares up, where on the body pain is sensed, and the level of severity of pain and its influence your mobility. A medical history may also incorporate information on your sleep patterns and dietary habits, exercise routines and average activity level, and how symptoms are reduced or worsened by activity or composure.

A physical exam is implemented, which may incorporate feeling along the spine for malformations (palpation), a range of motion test and or a reflex examination that involves bending the spine forth, behind, or to the side.

An imaging test may be requested in some cases to find or verify disc degeneration in the spinal column. An MRI scan is usually employed for presumed disc degeneration, which can show disc dehydration or a herniated disc, tears or fissures in the disc. A dehydrated disc may be referred to as a dark disc or black disc because it looks darker on an MRI scan.
See Introduction to Diagnostic Studies for Back and Neck Pain

Degenerative Disc Disease.
It is imperative to note that the amount of pain does not equate to the amount of disc degeneration. Critically degenerated discs may not create much pain at all, and discs with little degeneration can produce critical pain—some studies have observed prevalent disc degeneration in people not experiencing any disc pain.1,2

For this purpose, a diagnosis of degenerative disc disorder should regularly rely on a blend of medical history, a physical exam, and any imaging tests dictated.

As a final note, it is helpful for patients to know that the amount of pain does not correlate to the amount of damage in the spine. Severely degenerated discs may not produce much pain at all, and discs with little degeneration can produce severe pain. What this means for patients is that even if they are experiencing severe pain, it does not necessarily mean that there is something seriously wrong with their spine and does not necessarily mean that they need surgery to repair any damage.

The goals of degenerative disc

Surgery to approach degenerative disc disorder usually is only recommended if the pain is severe and non-surgical treatments, such as pain medications and physical therapy, are ineffective. The goal of surgery is to alter the underlying mechanisms in the spine causing pain, such as excessive micro-motion, inflammation, and muscle tension.

Spinal fusion for degenerative disc disease
Before deciding whether to have the procedure for degenerative disc disorder, patients should recognize the risks and benefits.

Nonsurgical treatments are typically recommended for no less than 6 to 12 weeks before surgery is contemplated, although in most cases nonsurgical treatments are used for much longer. It is predicted that only between 10% and 20% of lumbar disc degeneration cases and up to 30% of cervical disc degeneration cases are not successfully administered and treated with nonsurgical methods, and justify surgery to relieve pain and improve mobility.4

Considerations Before Spine Surgery
There are several factors to consider before opting for surgical treatment if it is recommended, including:

Recovery process. The recovery period following after spinal surgery can include a combination of pain medications,physical therapy, or wearing a back or neck brace
Lifestyle considerations. The usual routine lifestyle adjustments required for either non-surgical or surgical therapy may be significant. In the event of surgery, a long recovery process may demand significant time off from your employment. Additionally, conventional physical therapy and pain management will be needed for optimal outcomes.
Imaging indication of disc degeneration. Spinal surgery for degenerative disc pain is commonly only prescribed if an imaging scan linked to the specific purpose of pain, and even then outcomes are not always anticipated.

Spinal surgery is always optional, meaning it is the patient’s decision whether or not to have the procedure. The spinal fusion is the most standard procedure practiced for degenerative disc pain. In recent years, artificial disc replacement has grown more extensive as devices, and surgical methods have developed.

Spinal Fusion for Degenerative Disc Disease
During a spinal fusion procedure, two adjoining vertebrae are grafted unitedly to alter the underlying mechanisms producing pain. A fused joint reduces instability at a spinal segment, lessening pain produced by micro-motions, muscle tension, and swelling. Joint fusion can also provide a more precise decompression of pinched nerves.

Spinal Fusion Procedure

A spinal fusion procedure typically consists of the following steps:

  • Under general anesthesia, a cut/incisions are made to access the spine. For a cervical fusion, the incision is generally made in the anterior of the neck. For a lumbar fusion, a cut may be made in the posterior, front, or side of the body.
  • Muscles encompassing the spine are cut away or shifted to the sides to reach the spine.
  • The degenerating disc is separated from the disc space.
  • A bone graft or devices are fixed across the disc space to stabilize the spinal segment and promote bone growth.
  • The spinal muscles are repaired or reattached, and the incision site is sealed with stitches.

A fusion surgery sets up the mechanisms for bone growth, and the fusion occurs in the months following the procedure. For this reason, the complete healing process from a fusion surgery can continue up to a year, although a majority of patients are back to their regular daily routines within six weeks.

Following surgery, use of a back or neck brace may be recommended to keep the spine secured and to lessen painful movements that can threaten the healing process. Also, physical therapy is customarily suggested to condition the muscles improve to support the spine, and pain prescriptions are ordered to manage post-surgical pain.

Artificial Disc Replacement Surgery
Degenerative disc pain can also be undoubtedly decreased or eliminated by inserting a device that mimics the native support and motion of a spinal disc in a procedure referred to as Artificial Disc Replacement (ADR). Unlike spinal fusion, this procedure is specified to preserve motion at a spinal segment after surgery.

In this procedure:

  • The spine is accessed through a small incision under general anesthesia. During a cervical ADR, the incision is typically made in the exterior of the neck; during a lumbar ADR, the incision is customarily made in the back directly over the spine.
  • The muscles are shifted to the side or cut apart from the spine.
  • The degenerated disc is discarded entirely, as is any decayed portions of the spinal joints or contiguous vertebrae in the disc space.
  • The artificial disc is implanted into the disc space leveraging x-ray imaging to lead the device. Some devices also incorporate metal plates that are connected to either vertebra overlooking the disc space.
  • The muscles encompassing the spine are reattached, and the cut is sealed.
  • Artificial discs are generally constructed of plastic or metal materials. The rehabilitation process from an artificial disc replacement includes typically a combination of physical therapy, pain medications, and perhaps wearing a neck or back brace. Healing from this operation can take up to 6 months.