Understanding and Managing Degenerative Disc Disease

May 20 08:58 2021 Print This Article

The spinal column is one of the most vital parts of the body. It supports weight and helps manage most of our movements. It is home for the spinal cord which sends signals from the brain to different parts of the body through the spinal nerves.

The column is made of several bones called vertebrae separated by discs, called intervertebral discs. These discs provide cushioning to the back, hence easing movements such as bending, twisting, jumping etc.

With time, these movements cause wear and tear of the discs, especially after the age of 40. This results in a condition called degenerative disc disease (DDD) or intervertebral disc disease (IDD). The name is misleading as there is no degeneration that is happening continuously, only age-related wear and tear. Further, it’s not a disease, but a condition that can be managed well. In addition to age-related wear and tear, injuries due to sports, falls and vehicle accidents can also trigger and/or hasten DDD.

Causes

IDD does not have a single cause or nature of the problem but rather one or more inter-related events.

• End-plate cartilage erosion: Every pair of vertebra and disc is separated by a layer of cartilage called the end plate. This end plate allows oxygen and nutrients to enter and leave the disc. Age-related wear and tear causes the discs to wear down as well as erode the end plate. As the end-plate erodes, the supply of oxygen and nutrients to the disc is affected, which causes the disc to degenerate further, like a vicious cycle. However, please note, this process happens over a long period of time.
• Disc space collapse: As the end plate and discs continue to erode, at one point of time, the disc space collapses. This puts a strain on the muscles holding up the spine, and further, the space between the adjoining vertebrae shortens, leading to unwanted movement in this space, which makes the spine unstable.

Cracking of annulus: The disc is made of a hard outer wall called annulus that is composed of individual, collagen, lamellae fibers, and a soft center called nucleus pulposus. With age-related wear and tear, some of the collagen fibers split or rip off. Over time, this creates a crack in the outer wall. The crack makes the disc lose those properties, which cause cushioning, leading to intense pain. Although the tear in this tissue causes a scar to develop in its place, the scar tissue is not strong or durable as the original tissue making up the disc wall.

• Disc herniation: In some people, when a crack develops in the annulus, the soft pulp inside may ooze out or push out of the crack. This condition is called a herniated disc. The herniation can pinch the spinal cord and nerves.
• Drying out of nucleus: The soft gel that makes up the nucleus pulposus is largely made of water. With time, some of this water dries out making the gel harder. This reduces the cushioning effect of the discs. In some cases, the drying is so much, the nucleus collapses. The vertebrae above and below the collapsed disc rub against each other and become misaligned. This improper alignment causes the joints where the vertebrae meet, called facet joints, to twist unnaturally. In order to compensate for this and make the spinal column stable, bone spurs called osteophytes grow in that area. These bone spurs pinch the spinal cord and nerves causing a condition called spinal stenosis.

Risk Factors

There are various risk factors for DDD, and being aware of them helps you take corrective action and prevent the onset of DDD.

• Obesity: This increases wear and tear with time, compared to a person with a healthy weight
• Strenuous physical work: Sportspersons and people who need to lift or carry weights all the time at work are more prone to this wear and tear
• Tobacco smoking: Tobacco consumption in any form reduces oxygen supply to most parts of the body including the discs, hastening DDD
• Falls and injuries: These can cause a crack in one or more vertebrae or discs at the point of impact. This can trigger DDD in younger people and hasten DDD in elders.

Symptoms

• Pain in the neck, radiating to shoulder and upper arms
• Pain in the lower back radiating to buttocks and upper thighs
• Intermittent, nagging or severe pain that lasts from a few days to a few months
• Pain is bad when you bend, lift, twist, or sit but lesser when you move or walk
• Pain reduces when you change positions or lie down
• Numbness and tingling in the arms and legs
• Weakened leg muscles leading to leg pain and stiffness in the legs
• Foot drop: inability to raise front part of one or both feet
• Pain when there is prolonged sitting or standing like a long car trip or an airplane flight
• Pain that worsens with time, making daily activities difficult
• Muscle spasms in the lower back or neck
• Flashes or flare-ups of intense pain

Diagnosis

An orthopedic doctor or spine surgeon will examine you to assess the extent of DDD.

• Physical examination that looks for muscle strength, pain during movement or in response to touch, and nerve function (using a reflex hammer)
• Imaging scans such as CT, MRI, spine X-ray, and, in some cases, discogram

Treatment

Exercise: When the condition is mild or early-stage, exercise is the most preferred option. This strengthens the back muscles, stabilizes the area around the affected discs, and increases mobility. Exercise options include swimming, walking, cycling, aerobics, yoga, pilates, and weight-training under supervision. The consulting doctor will teach you many free-hand exercises that will strengthen your core.

Physiotherapy/Physical therapy/Chiropractic manipulation: When the condition is moderate, these will help relieve the symptoms till such time that the person is able to exercise.

Medication: Pain killers, NSAIDs, and other drugs, such as acetaminophen, ibuprofen, meloxicam, gabapentin, etc. are given when the pain is manageable. If the pain, swelling, or inflammation are severe, steroid shots are given.

Surgery: There are both permanent and regenerative options, including discectomy, spinal fusion, stem cell therapy, platelet-rich plasma, and prolotherapy.

Others: These include transcutaneous electrical nervous stimulation, massage, and ultrasound treatment.

Outlook

Degenerative disc disease is preventable by leading a healthy lifestyle and manageable when detected or treated early. If you or your dear ones are diagnosed with DDD, consult an orthopedic or spine surgeon at a reputed hospital like Kauvery Hospital. With their branches widespread in cities like Chennai, Trichy, Hosur, Salem, and Tirunelveli, you can have access to their expertise no matter where you are located. Their qualified and experienced orthopedic and spine surgeons will diagnose your condition precisely and design a course of treatment for quick recovery and rehabilitation, offering a comprehensive and integrative approach to your healthcare needs.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801