Degenerative Disc Disease

Degenerative disc disease can develop in any section of the spine depending on which moves the most, but typically develops in the lower back or the neck.

Known as lumbar one to lumbar five (L1 to L5), the largest bones in your back are found in the lumbar spine. These vertebrae  have spinal discs separating them, and degenerative disc disease affects this portion of the back nearly 90% of the time.

The other common area of the spine affected by degenerative disc disease is the cervical spine–specifically the seven vertebrae found in the neck. As the cervical spine is responsible for the most movement (turning the head from side to side, as well as looking up and down), wear and tear on the discs between these vertebrae can lead to pain.

When changes occur in the spinal discs, pain can occur. Once cause of degeneration is the normal drying out of the discs. At the time of birth, the discs are primarily made of water, and over time they form a soft inner core and a tougher outer wall, losing water and becoming thinner with less cushioning, making it more difficult for them to absorb shocks resulting from normal daily movement.

Another cause of pain is cracking or tearing near the nerves on the outer walls of the discs. Stress and strain on the back as the wall breaks down results in the soft, inner core pushing through those cracks. Sometimes this may lead to bulging or what is often called a herniated or “slipped disc,” affecting the surrounding nerves causing pain. These tears can be the result of injury from a fall or overexertion during exercise or heavy lifting.

The most common risk factors for developing degenerative disc disease are family history, smoking, heavy lifting, aging, overexertion from exercise or manual labor and being overweight.

Normal degeneration occurs as we age, with nine out of ten people showing signs of pain and wear and tear by the age of 60. Spinal damage also results from excess weight, which puts stress on all parts of the spine.

Those with a parent or other family member with a history of degenerative disc disease are at a higher risk, as inherited genes may increase risk.

Degenerative disc disease can be prevented by using caution and care when doing any type of heavy-lifting or excessive exercise. Additionally, maintaining a healthy body weight and active lifestyle can lessen the risk for pain resulting from degeneration.

Symptoms of degenerative disc disease include constant or sharp pain in the neck or back, depending on which discs are affected by degeneration. Symptoms can be severe but not necessarily constant. Extreme cases may cause tingling or numbness in the limbs, or weakened leg muscles as a result of damaged discs affecting the spinal nerves. Symptoms often feel worse under certain circumstances, such as bending, twisting or lifting. Many also feel more pain when sitting rather than standing or walking, and get relief upon changing positions or lying down.

Symptoms and discomfort may feel like pinching or compression, and in cases of pinched nerves may lead to pain in the limbs, hands, buttocks and thighs.

Doctors will take a detailed history of symptoms, including onset of pain, areas of the body experiencing pain, injuries, and any related family history. They will likely perform an X-ray or MRI to detect any nerve or bone damage near the spine. You will typically also be asked to move, bend, or walk to determine the types of movement that causes pain.

Treatment of degenerative disc disease will focus primarily on preventing any further damage and pain management. Following diagnosis, your individual recovery plan may include one or more of the following treatments:

• Physical therapy: Many patients are able to manage their degeneration diagnosis by working with a physical therapist on specific movements that help build the supportive muscles in the neck and back, increasing flexibility. 
• Medication: Inflammation or muscle spasms causing pain may be easily reduced with over-the-counter pain relievers, such as ibuprofen, naproxen or aspirin. Stronger drugs may be prescribed, though caution should be exercised due to high risk of prescription drug dependence.
• Radiofrequency neurotomy: Using radio waves that heat and destroy nerve tissues in the spine can prevent pain signals being sent to the brain from damaged nerves. This treatment may provide immediate pain relief for some, while others don’t experience the benefits for up to three weeks.
• Steroid Shots: An injection of steroids into the lower back may reduce swelling, inflammation and ease pain. This shot is performed either directly into the nerve or muscle being affected, or may be injected into the epidural space of the back. 

In more serious diagnoses, surgery may be recommended. An artificial disc replacement involves removal of the disc that is causing pain, and replacing it with a plastic or metal disc. A spinal fusion surgery is a procedure where the damaged disc is removed and replaced with a bone connecting the bones below and above where the disc once was. Relief may also be achieved with only part of the damaged disc removed in a procedure called a discectomy. 

Other surgical procedures wherein a portion of the bone is removed as well as the damaged portion of the disc include a foraminotomy, laminectomy or a laminotomy. 

Pain management options may include massage therapy for temporary relief, weight loss and posture correction. Focusing on sitting and standing differently results in muscle development that can support the realignment of vertebrae, ultimately preventing pain.

Many living with degenerative disc disease get relief by using a transcutaneous electrical nerve stimulation device, or “TENS.” This treatment gives small, regular electrical impulses to pain points. These devices can be purchased over-the-counter, and provide a tingling sensation to the muscle group, rather than additional pain.

Regular exercise–including swimming, gentle yoga, stretching, pilates and tai chi–also provides pain relief, though should be done in conjunction with medical advice. Hot and cold therapy can also reduce inflammation, alternating between a heating pad and a cold pack every 10 to 15 minutes three to five times a day can provide immediate relief.