Degenerative Disc Disease
As we age, changes in our bodies and “wear and tear” can bring about degenerative disc disease (DDD), a condition common in older adults. Not technically a “disease,” DDD includes stress and damage to intervertebral discs over time, whether by trauma, injury, repetitive movement, improper posture, poor body mechanics, and being overweight. At the Advanced Spine Institute of Greater Boston, we see and treat a wide range of DDD cases every year.
Each disc is composed of a rugged casing (the annulus fibrosis) around a jelly-like substance called nucleus pulposus. Endplates anchor each disc in place between two vertebral bodies. These “shock absorbers” are particularly vulnerable to age-related degeneration. They serve as spacers between the vertebrae and help the bones of the spine deal with the pressures of walking, running, and movement. Degenerative disc disease (DDD) is a general term used to describe these degenerative and often age-related changes in the discs.
Discs do not heal or repair themselves. In cases of DDD, there are various ways in which discs become damaged, ruptured, brittle or misshapen, including:
- Drying out (less fluid inside and less ability to absorb shock)
- Flattening (providing less spacing)
- Stiffening (less cushioning power)
- Bulging out
- Rupturing or herniating
In some cases of DDD, the nucleus pulposus inside the disc can leak out. If this substance comes in contact with nearby nerves, it can irritate them and cause considerable pain. Since the spinal column is the “nerve center” of the body, ruptured discs are very likely to irritate nearby nerves.
Causes of Degenerative Disc Disease
By far the most common cause of degenerative disc disease is aging. Even if there is no direct damage to the disc, the stiffening and wear of tissue in all parts of the body can cause sufficient stress on the disc to cause it to flatten or microscopic tears to occur. Degenerative disc disease can also occur in response to repetitive stress on the spine.
Symptoms of Degenerative Disc Disease
Degenerative disc disease may be challenging to diagnose at first because the symptoms may come on gradually and be dismissed at first, particularly in seniors who accept some “aches and pains” as a normal part of growing older.
The pain of degenerative disc disease may be mild to severe. In some people, it is a dull ache, but in others the pain can be incapacitating. The pain is typically localized to the area affected, that is, if the degenerative disc disease occurs in the lower back, the pain will be in the lower back. In some cases, people with degenerative disc disease may find pain relief by lying down.
In more severe cases, there may be numbness, tingling, “pins and needles,” or weakness in the arms and hands or legs and feet.
Diagnosis and Treatment
A diagnosis of degenerative disc disease is usually confirmed by physical examination, medical history, and certain tests, which can include:
- CT or MRI scan
- Myelogram (a contrast scan)
The treatment of degenerative disc disease will depend greatly on your overall condition, the severity of your symptoms, the location of the problem, and your own preferences.
- Conservative treatment may include bed rest, activity restrictions, and pain relievers
- Anti-inflammatory medications, physical therapy or epidural steroid injections may be recommended in some patients.
- Surgery, including minimally invasive procedures, may be appropriate for certain patients.
Surgery for Degenerative Disc Disease
Surgery is not indicated for every patient, but your physician at the Advanced Spine Institute of Greater Boston may consider it an option based on your specific condition and symptoms, and will walk you through the benefits and risks of:
Minimally invasive interbody fusion removes the damaged disc and then joins the two vertebrae together (fusion) using an implantable device (the “interbody”) as a spacer and stabilizer. It can be performed with only a small incision and may be done on an outpatient basis in appropriate candidates. In other cases, the damaged disc is removed and replaced with an artificial disc to provide support and spacing. A discectomy refers to the removal of the disc which may be followed by fusion. Laminectomy is a procedure in which part of the bone of the vertebra is removed in an effort to relieve compression on the nerves.