What is Degenerative Disc Disease?
Rheumatology related illnesses and disorders are on the rise because of changes in lifestyles brought about a new globalized world, which has technology at its heart.
This has increased people with sedentary lifestyles and has made many prone to spending hours glued to screens whether they be of laptops, smartphones or tablets.
Contrary to popular belief, sitting down is a position that puts tremendous stress on the back and as vocationally less people are involved in manual labor the number people who risk hurting their backs rises.
Degenerative Disc Disease is a condition that is far more common than people know. It has a close relationship with other musculoskeletal conditions such as arthritis and osteoarthritis.
The term Degenerative Disc Disease is actually a misnomer, as it is not actually a disease and it is not degenerative in the usual sense of the word.
It can more accurately be called a disease related to aging. Over a period of time the stresses that accumulate on the spine and back start to manifest themselves, while for some it may produce no problems, for others there be sharp and chronic pain, particularly in their spinal discs.
The term for the disease does not describe the symptoms but explains the process of discs worsening over as a person advances in age. It is not necessary that the pain worsens over a length of time, rather the pain can be alleviated given enough time and rest.
Degenerative Disc Disease is not a disease, but a degenerative condition resulting from pain produced by a damaged disc.
While in theory degenerative disc disease can affect any part of the spine, it is most frequently experienced in the lower back and the neck.
Disc degeneration in itself does not produce any symptoms but the degeneration brings about circumstances inflammations and movements which manifest as painful symptoms.
The Human Vertebrae
The human backbone, also known as the vertebral column or spine is one of the most important parts of out skeletal composition.
The vertebral column is normally composed of thirty-three vertebrae. The upper twenty-four are flexible and divided from each other through the intervertebral discs, while the lower nine are fixed.
The intervertebral discs, also called spinal discs, have different compositions on their outside and inside.
The outer part is tough and fibrous while the inner core is soft and gelatinous in nature. Spinal discs have important physiological functions.
They are essential in maintaining the flexibility and elasticity of the spine, and therefore are the reason that we can bend our backs and then return them to the upright position.
Besides the articulation of the spine, the discs serve as important shock absorbing centers of the spine.
They distribute the pressure and bear the brunt of the stress when the spine moves or bears some sort of weight.
The Makings of the Condition
The intervertebral discs are at the epicenter of Degenerative Disc Disease. As a person ages the vertebral disc’s internal gelatinous core, which is approximately 90% water, starts to lose its water content and consequently start to slightly shrink.
This decrease in the lateral size has a direct impact on its shock absorbing abilities. Upon losing its original consistency the depleted padding becomes a less efficient stress absorber.
Moreover, due to the collapse in its height the vertebrae come in closer contact with each other. When a load is lifted, the stress impact that was once cushioned does not have as effectively and the discs hit each other.
In the absence of the discs holding the vertebrae apart from each other, their rubbing and collisions can produce another problematic symptom in the form of bone spurs.
Bone spurs are abnormal bone growth which can hit the nerves or their roots and aggravate the symptoms experienced by developing conditions such as sciatica.
The friction and the impact from the collision result in pain, which can be of varying degrees.
The body responds in a variety of ways which may worsen the condition by mechanisms such as the bulging of the vertebrae.
When this pain is chronic and situated primarily in the lower back, then it has the markings of degenerative disc disease.
The outer tougher part of the intervertebral disc called the annulus can experience tears. The gel like material can then escape through the tear in the wall and reach the nerve outside.
The gel-like material is rich in inflammatory protein which irritate the nerves and cause them pain.
Small movements by the discs can also cause pain when they start travelling the vertebral segment. With the passage of time the proteins become used up and the dry disc starts becoming stiffer with limited micro-motion.
These changes alleviate the strong pain that persisted in the region. Wear and tear and a history of poor posture can have a detrimental effect on spinal health.
This degeneration occurs in everyone, but becomes aggravated in certain individuals who are predisposed to developing back problems, or those whose vocation puts them at a progressive risk.
The Symptoms of Degenerative Disc Disease
The trajectory of the pain experienced by patients can be described as: a significant injury with subsequent sudden and unexpected pain, a minor injury with subsequent and sudden back pain and a pain that starts gradually but exponentially becomes worse over time.
The areas most affected by Degenerative Disc Disease are the lower back and the neck. The lower back area is called the lumbar region and the neck area is called the cervical region.
Pain centered in these regions is called Lumbar Degenerative Disc Disease and Cervical Degenerative Disc Disease. The spread of the disease is not limited to the initial locations of pain, rather it affects the surrounding regions too.
The response to varying degrees of degeneration is mixed among the population. The pain may also radiate to other regions of the body such as the hips, buttocks and thighs.
These symptoms are experienced while conducting every day activities such as walking. Other limbs may also suffer, with the knees and fingers being at the forefront.
Pain will also afflict in stationary positions such as sitting and in more exertive positions of bending, twisting and lifting.
The stationary sitting position belies, the amount of weight that it puts on the spine. Numbness and tingling sensations are also associated with Degenerative Disc Disease and are largely felt in the fingers and knees.
The sufferer may feel weak and apparently have limited strength in these areas. The onset of the disease maybe become noticeable after either a major injury or after normal body flexing.
A look inside the anatomy can provide valuable insight into the mechanism of this condition.
The subsequent response to an injury, may cause certain areas of the vertebrae to become inflamed.
Inflammation may cause pain because of the proximity to nerves and the pain in this case would be infrequent and erratic or in other cases recurring.
In some people their biological make up puts them at greater risk of pain. For example, in some skeletal formations nerve ending enter the tough outer fibrous part of the discs more deeply.
As the nerve endings are deeply embedded, the person is more susceptible to the shooting pain which will result from the aging of the discs.
The predominance of the degenerative condition in the lower back, the lumbar region, results from a compromised lower vertebrae.
The cause of the onset may be influenced by a multitude of factors or from a single traumatic trigger. As the intervertebral discs are not furnished with their own supply of blood, they cannot repair themselves like other tissues in the body.
So, even minor injuries which may have been easily repaired by a supply of decent blood vessels may snowball into something devastating and debilitating.
Lumbar Degenerative Disc Disease may arise from one or both of the possible sources:
Inflammation: proteins from the depleting disc are released and end up irritating the nerves present in that area, the result of which is inflammation.
Abnormal micro-motion instability: the outer portion of the disc is in the form of annular rings. As this fibrous layer is worn out with time, it becomes ineffective as a stress absorber and starts to move along the vertebral axis instead of cushioning the stress.
However, contrary to its name, as time passes the pain largely subsides due to the anomalous response of the body.
The reason for this is when a disc becomes completely degenerated it stops producing secretions which would irritate the nerves and cause inflammation and the depleted disc eventually falls back into a stable position which rids the body of the pain that was caused by small movements along the vertebral segment.
The pain linked to lumbar affliction of Degenerative Disc Disease is of a low threshold that continues, but remains tolerable.
Although there remains an off chance that will sometimes shoot up and become unbearable. The pain mostly occurs as a back breaking ache in the small of the back and not a pain that has the quality of burning.
The pain is worse in the sitting position because of the increased load on the spine in this position and contracting movements involving flex further increase the pain.
On occasion if the disc collapses and compresses the nerve root, it may cause the nerve to become pinched and can seriously impact the legs. Although the pain is transitive, it rarely goes below the knees.
Cervical Degenerative Disc Disease
The other area predominantly affected is the cervical region. Although it is the primary cause of pain in the neck, usually experienced by a stiff neck, the occurrence in this area is far less common than in the lumbar region.
The reason attributed to this is that the neck is generally subjected to far less stress and pressure than the back.
The distribution of pain occurring in the cervical region spreads, similar to pain originating in the lumbar region, to areas below the neck such as the arms and shoulders.
The main cause of this pain is also similar that it is, the nerves in these areas become, irritated by protein secretions or pinched under the pressure of the collapsing disc.
Unfortunately, it can also set certain other progressive conditions in motion such as cervical stenosis and disc herniation.
Degenerative Disc Disease Diagnosis
The disease is diagnosed with physical examination accompanied by recording extensive medical history.
The patient will mention all the symptoms felt in detail and any injuries or illnesses that may have expedited the onset.
Lifestyle habits may also be questioned in the effort to determine the root cause. Bad posture and manual labor which puts frequent stress on the back can, over time, progress into Degenerative Disc Disease.
In the physical examination special attention will be paid to the lower back and the neck.
The purpose of the exam is to map out the areas afflicted with the condition and determine the degree of deterioration by checking the extent of movement that has been impaired.
The doctor will also be on the lookout for any visible nerve damage, which presents itself in the form of numbness, tingling and loss of strength in the affected areas.
A patient could also be examined for other conditions that may have overlapping symptoms such as tumors, infection and fractures.
Physicians and surgeons would then conduct neurological exams. Testing reflexes, the curvature of ones spine fall inside this category.
The doctor will proceed by asking questions and moving on to the problem areas based on responses to questions and pain.
If the physical examination reveals no accurate indicators the next step is to move towards medical imaging.
These provide descriptive visual insights into the internal happenings of the body. Scans like computerized tomography (CT), magnetic resonance imaging (MRI) and X-Rays provide the requisite medical imaging for a clearer picture of what is going on in the area.
X-rays are able to illustrate fractures and stenosis, to be thorough doctors may order shots from different orientations to gather a three dimensional idea of the spinal area.
The X-rays used for degenerative disc disease detection differ from the ones normally ordered, they capture images of the spine in both flexion and extension.
These flexion and extension X-rays gauge the integrity of the spine when subjected to everyday stress.The former are particularly useful as they enable doctors to spot the anomalies on the bones.
CT scans in particular are able to show whether a portion on the vertebrae is pressing on a nerve or not.
If it is likely that a nerve has been affected then the next test ordered is the electromyography (EMG), which measures nervous response reaction rate in the background of various stimuli.
The diagnosis takes time becomes of the common symptoms found in other illnesses and the multitudes of disorders triggered by degenerative disc disease.
A doctor may be able to assess that a herniated disc is present, but detecting whether it was caused by a degenerative disc or not, is tricky and complex.
Novel diagnostic methods like the bone scan involve injecting small pieces of radioactive material into the bloodstream which traverses the body and eventually winds up in the bones. A machine scanner can then detect signs of the abnormality in the bones.
For some cases a doctor may order blood tests to rule out the possibility of other diseases that can be detected by the presence of some markers in the blood. Examples of diseases diagnosed in this manner include rheumatoid arthritis.
Degenerative Disc Disease Treatment
The treatment plan for degenerative disc disease is largely similar for both the lumbar and cervical region. The treatments involve passive and active strategies.
Passive treatment or strategy is received or done to the patient in order to alleviate his or her symptoms.
Active treatment are methods advised to the patient, who has to carry them out in order to regain his or wellbeing.
Mostly a combination of the active and passive treatment is prescribed to patients as the success rate and speed of alleviation is high in this way. Medical history of various patients suggests that one treatment method done on its own is rarely effective.
Surgery is the oft avoided path and is used in only extreme cases where no relief from traditional conservative methods can be accorded to the patient.
The goal of the procedure is to halt any painful micro movement and decompress the spread out spinal nerve. Spinal fusion is the go to method in which the bony vertebra/e are permanently fused together to provide stability to the spine.
This procedure is mostly performed in the lumbar or cervical regions because they provide the most degree of movement.
Intradiscal Electrothermal Therapy is the other commonly used invasive procedure. It utilizes a catheter which directly heats the spinal discs to shrink out the tears in the annulus, the tough fibrous part of the disc. It also conditions the nerves to be able to overcome the discogenic pain.
Passive Treatments
Passive treatments use pain killers, medical narcotics and muscle relaxants to assuage the pain of the patient. All of them have their advantages and disadvantages and the type of medication subscribed will depend on the type of pain and other factors.
Chiropractors play a vital part in the treatment of spinal related disorders. Chiropractic techniques such as spinal adjustment and manipulation are known to provide relief from the apparently chronic pain of degenerative disc disease.
The focus on reducing tension in the muscles, reducing pressure on some sensitive nerves and treatments aimed at inducing the body to release natural painkillers called endorphins.
A patient can also consider ultrasound treatment which warms the tender area and tries to heal the area by regulating blood flow. Therapeutic massages are also commonly resorted to and have goals similar to the chiropractic methodology.
Epidural injections are also regularly employed to treat the pain. They deliver a dosage of steroids which reduces the inflammation in the pain prone region.
Active Treatment
Exercise on part of the patient is an effective therapeutic technique that increases blood flow to pinched areas. Once a healthy blood flow is replenished to sensitive areas, patients will feel noticeable change in their pain status.
Giving up smoking is a sacrifice one has to make in order to save oneself from a myriad of diseases, degenerative disc disease being one of them.
Cigarettes contain tar and nicotine along with many other toxins that put the body at the risk of many diseases as well as adulterating the blood stream which reduces is oxygen carrying capacity and disturbing the composition of its plasma.
This can be harmful to the body in the long run as it also suppresses the body’s ability to cope with different debilitations.
Weight loss is a no brainer. The heavier you are the more pressure you put on your skeletal structure.
If the heavy weight is accompanied by a sedentary lifestyle which shirks from all forms of exercise then the problem is compounded and the risk of developing DDD early one increases significantly.
Ergonomics is the future of a sustainable workplace and home. You would be surprised to know that many office related injuries have nothing to do with heavy lifting or lots of manual labor, but with bad postures and repetitive work done in that posture.
Posture plays a central role in the spread of most musculoskeletal diseases. The correct practice could help prevent this problem and help reduce this problem.
Employers should be urged to supply their employees with comfortable arrangements to extract maximum productivity out of their employees.
Such an arrangement will benefit both parties, and will keep the employees productive over a long period of time by making them less prone to injury.
When one thinks about back pain treatment and the spine, the word surgery immediately comes to mind.
Surgery, however is not a very viable option in most mild cases because spinal surgery is incredibly risky and complicated.
Therefore, it is for the best to avoid and invasive methodology, for fear that things may go awry and spawn other problems.
It is best to wait out the pain by management and rehabilitation techniques because as age increases the degree of movement and hence pain decreases as the disc becomes stiffer.
Any treatment or therapeutic method aims at making the pain manageable so that the patient can engage in physiotherapy that can improve posture and advise lifestyle changes.
With the correct treatment program, an individual can gain enough mobility to carry out ordinary functioning at home and work.
Physical therapy and exercise are very important roads to recovery. The challenge, however lies in making the pain manageable enough to engage in these exercises. Exercises aim at reviving a continuous blood flow through the tender regions and helping the body gain back its lost mobility.
Alternative medicine or holistic therapy has been making inroads for a long time coming. Many people report relief brought about by alternative medicines and these trends have spiked with the embrace of the new age culture.
Acupuncture, biofeedback and herbal remedies are some popular treatments sought by back ache patients. These treatments may provide useful coping mechanisms and improve overall health.
However, it is important to consult the doctor before taking any alternative treatment up, as it may interfere with other ongoing treatments.
Degenerative Disc Disease Prevention
It is sad that unfortunately doctors do not know the exact cause of degenerative disc disease. While it is speculated that age, injury and other conditions such as arthritis and osteoporosis play a big role in it.
Lifestyle changes can have the most marked impact in reducing your susceptibility to degenerative disc disease.
Changes in behavior will not go to waste and the reward will come in the form of heightened wellbeing and increased coping mechanisms.
One should be mindful of what one eats, is a maxim that fitness buffs love to live by and rightly so. Our diet is the direct source of our building material.
With the diet we maintain our body and keep on providing essential nutrients that aid the repair and building processes of the body.
A diet rich in leafy greens, whole grain, nuts and healthy dairy are valuable for spinal health.
Whereas foods rich in fat contain plenty of toxins that can be detrimental to our health. Alcohol and tobacco are also poison when it comes to maintaining spinal health, as they produce undesirable consequences within the body.
The human body is composed primarily of water and so it is no wonder that it requires plenty of it to maintain itself and grow.
The underlying cause of degenerative disc disease is the loss of water in the intervertebral discs. By staying hydrated all the time an individual could replenish the essential water lost and can help the disc to stay strong.
Having a habit of drinking lots of water is also known to aid in the regulation of weight, as it reduces the need to unnecessarily snack when one is not really hungry.
Weight loss has a direct correlation with spinal health. The lesser a person weighs, the less pressure on his spine and skeleton as a whole to maintain mobility.
Muscles are the most essential tissues which are responsible for the motor motions of the body. They help the body bear the brunt of strenuous impact by bearing it and supporting the skeletal structure.
Muscles also require maintenance and nourishment to grow further. The best way to sustain muscles and grow more is by exercising regularly.
Regular exercise not only builds muscles but makes them more resilient to injury and sudden impact.
Another beneficial by product is improved blood flow. A powerful and unimpeded blood is most desirable as blood carries with it numerous beneficial nutrients that can repair damaged cells and tissues.
Changing habits can be difficult, especially the ones that have been with you for as long as you can remember.
Your posture is something that you carry into adulthood from your young age.The posture is your gait when walking and sitting, it determines the amount of stress that your spine induces when carrying out mundane everyday activities.
A proper posture becomes all the more important when the job description involves work that puts pressure on the spine or involves tasks of a repetitive or cyclic nature. In such cases the use of ergonomically sound furniture and devices can knock off the years off your spine.
The very foundation of ergonomics is the design of equipment and devices that prevents musculoskeletal disorders.
However, despite all the precautions that one takes certain factors the likes of which include genetic predisposition and nature of vocation put a person at risk of developing the disease earlier than it is expected.
Moreover, degenerative disc disease is related to aging, and as the body ages it will, regardless of the lifestyle, still not retain its original consistency forever, but it will make any discomfort more manageable and surmountable.
Degenerative Disc Disease and Sciatica
What is Sciatica?
Sciatica is a medical condition characterized by pain radiating from the leg to the lower back. The pain may further go beyond the back side and can often travel to the front of the leg.
The symptoms are often present only on one side of the body but incidence of the pain spreading to the other side has also been documented.
Pain in the small of the back is sometimes present along with a certain numbness in the lower limbs.
As with degenerative disc disease the pain is most oft worse will sitting, because of the increased pressure on the nerve in that position.
The sensation of sciatic pain is that of a burning or searing sensation. The frequency can be regular to infrequent. The incidence of the condition increases in middle age.
Causes of Sciatica
Herniated Disc
Most of the time sciatica is caused by herniated spinal disc pressing on the lumbar or sciatic nerve. This bulged out disc then irritates the surrounding nerve and produces the sensation of pain.
Degenerative Disc Disease is also one of the causes of sciatica. When the motion caused by a weakened disc irritate the nerve by releasing inflammatory proteins, sciatic pain can ensue.
Due to the loss of water content, the exterior of intervertebral discs become more likely to rupture, and once they rupture, the bulge pressing against the sciatic nerve causes sciatica.
Bone Spur and Tumor
An overgrowth of bone spurs that press or irritate a nerve root may also cause sciatica as can nerves damaged by tumors that press against them.
Spinal Stenosis
As a person ages there lies a likelihood that his spine narrows down as it travels downwards. This mostly happens when ligaments become overgrown and tighten their hold.
This coupled with spurs from bones and slipped discs can also contribute. The sciatic nerve may get affected and the symptoms will be concentrated in the lower back and limbs.
Spondylolisthesis
Is the slipping of the vertebrae out of its position and if that vertebra is pressing against the sciatic nerve then it may cause sciatica.
Pregnancy
Sciatica may also be caused by pregnancy when the fetus presses against the sciatic nerve and cause sciatica with milder symptoms.
The condition does not cause any long term damage and often corrects itself. There is no known cure for the treatment of this type of sciatica.
Piriformis Syndrome
This cause of sciatica is extremely rare. The sciatic nerve passes through the piriformis muscle, if the muscle tightens or spasms due to a blow or overuse, it may compress the sciatic nerve and cause sciatica.
Diagnosis of Sciatica
The standard method for diagnosing sciatica is by a physical examination. The person will report the shooting and radiating pain which indicates that the nerve root is under some kind of stress.
There is also a diagnostic test that is associated with sciatica which consists of straightening the legs and raising them to produce the Lasegue’s sign.
The person is considered positive for the condition if pain is reproduced between 30 to 70 degrees of passive flexion of the raised leg.
Imaging tests such as the CT and MRI can also show herniation and slipped discs which can then be used in conjunction with the diagnostic test to ascertain the problem and suggest the best course of treatment.
Treatment of Sciatica
Like related conditions, the preferred course of action in sciatica is non-invasive controlled exercises and over the counter medication to manage the pain. Surgery is the last resort for people who do not respond to other methods.
Is Degenerative Disc Disease and Arthritis Same?
Arthritis is a disorder of the joints that causes inflammation in one or multiple joints.
It refers to different forms of joint pain and joint diseases of which there are more than over a hundred types.
As a musculoskeletal disorder its prevalence has increased markedly over the previous few years.
Joint pain is the conspicuous feature of this disease and this accompanied by swelling in the joints and persistent stiffness.
The pain is mostly caused by the inflammation around a joint which deteriorates if not cared for in a proper manner.
The disease will continue damaging the joint. This along with the routine wear and tear and forced muscle stresses on the stiff joints can worsen the condition.
Treatment of Arthritis
Unfortunately there is no known cure for rheumatoid arthritis and osteoarthritis. Treatment includes medication for pain management which is brought out by reducing the inflammation in the joint, changes in one’s lifestyle and using a brace.
The similarity between degenerative disc disease and arthritis is uncanny. Both disorders are associated with aging and musculoskeletal pain. They have a spectrum of symptoms many of which greatly overlap.
The condition known as osteoarthritis, which is the arthritis of the spine, describes the pain, inflammation and swelling of joints near the vertebrae, which are called facet joints.
When someone is affected by arthritis the cartilage between these facet joints breaks down. This can open the doors for spurs, stenosis and stiffness.
The reason for this close association between these disorders is attributed to the fact that the facet joints and intervertebral discs are part of the same three-joint arrangement.
There is a high likelihood that the degenerating discs put increased pressure on the facet joints eventually aiding the formation of osteoarthritis.
This appears to be why these conditions often occur in tandem. If both these conditions occur in the same person then the disease is known as spondylosis. Nonetheless, it is entirely possible for each condition to occur entirely independently of the other.
Common Symptoms between Degenerative Disc Disease and Arthritis
The common symptoms between degenerative disc disease and arthritis have a great degree of overlap as they are related conditions.
These include sciatica, neck and back pain, muscle weakness and stiffness, radiating pain, tingling or numbness in limbs and extremities
Conclusion
Degenerative Disc Disease is a debilitating illness that puts mobility, something we take for granted in jeopardy.
Healthy choices at a young age can help delay the onset of this illness and help us cope with it, if it befalls us.
The condition affects young adults and people nearing middle age. While a sedentary lifestyle may put people at risk, so would an overly active lifestyle with little rest.
Other indicators of good health may not affect the occurrence of the condition but do help in recovery. Clinical studies have demonstrated that people who smoke are at a greater risk of developing this condition than are non-smokers.
The same is also true for people with occupations that put a lot of stress on the spine or encourage the conducting of work in a bad posture.
Another unfortunate fact is that people who have the condition will most likely have family members who have the propensity to suffer from the same illness. Hence a hereditary factor is also at play here.
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Zigler, Jack, et al. “Results of the prospective, randomized, multicenter food and drug administration investigational device exemption study of the ProDisc®-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease.”Spine 11 (2007): 1155-1162.
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Kumar, Malhar N., Frederic Jacquot, and Hamilton Hall. “Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease.”European Spine Journal4 (2001): 309-313.
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