Degenerative Disc Disease in the Back

Degenerative Disc Disease in the Back

Though degenerative disc disease in the back is quite common among older individuals, receiving a diagnosis can still come as a shock for many individuals. As an individual approaches middle age, his or her body begins to react to the wear and tear that has been placed on it over the years. The spine is no exception, which is why so many older individuals experience chronic back pain and lower body discomfort. Still, assigning a name to what was previously considered just a “bad back” can be shocking, worrisome, and even depressing. By learning more about the condition, many patients come to learn that the term “degenerative disc disease” isn’t nearly as nefarious as it sounds.

Intervertebral DiscsThe intervertebral discs are saucer-shaped pads located between adjacent, articulating vertebrae (the bone structures that house and shield the spinal cord). Often compared to mechanical shock absorbers, discs are tasked with cushioning vertebrae and absorbing the stress and strain that is placed on the neck and back when the spine facilitates movement or bears weight. These responsibilities are possible thanks to the makeup of the discs’ two components: the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the disc’s outer shell. Due to the amount of strain that is placed on the neck and back, the discs must be tough and resilient. It is the annulus fibrosus that lends a disc its durability to withstand the pounding our bodies take when we run, lift heavy objects, twist, or perform virtually any other movement. The discs must also be able to adapt to the pressure that is placed on them, which is why the annulus fibrosus also possesses some degree of pliability. The annuli fibrosi are able to perform all of these tasks because of the substances it is made of, which include fibrocartilage and other fibrous materials. Located at the core of each disc is the nucleus pulposus. This gelatinous substance is mostly made of collagen and a water-retaining substance that allow the discs to be somewhat “squishy.” This is an essential characteristic of the nuclei pulposi, as it enables the discs to absorb and conform to the force that is placed upon the discs. The nucleus pulposus is also tasked with evenly exerting pressure in all directions within the disc so that no one part of the disc receives more wear and tear than another.

Degenerative Disc Disease

After learning about all of the functions the discs are tasked with performing, it’s likely become no surprise that discs can eventually tire, weaken, and break down. More specifically, the annuli fibrosi become frail and brittle and the nuclei pulposi lose water content. These changes make the discs less able to perform their responsibilities, and make the discs prone to become herniated and bulging.

Herniated DiscsWhen a disc becomes herniated, its nucleus pulposus has seeped through a crack or tear in the disc’s annular wall. The outer portion of the annulus fibrosus contains nerve fibers, which can become aggravated when the wall ruptures. This, combined with the fact that the nucleus pulposus contains inflammation-causing proteins, can lead to significant pain and discomfort. Symptoms can become even more intense if the extruded disc material presses against a spinal nerve, a nerve root, or the spinal cord itself.

Bulging Discs

In simplest terms, bulging discs are misshapen and appear to balloon or bulge outwardly. This occurs when the annulus fibrosus weakens to the point that it can no longer keep the nucleus pulposus within its normal boundaries. The annular wall does not rupture in the case of a bulging disc, nor does the nucleus pulposus seep into the spinal canal. Rather, the misshapenness of the disc is what can cause neural compression.

SymptomsWithout compression of a spinal nerve, many individuals can be afflicted with degenerative disc disease in the back without even knowing it. However, when the affected disc ruptures or protrudes and comes into contact with a neural structure, the condition can certainly make itself known. Symptoms can include pain, numbness, tingling, and muscle weakness, which will appear in different locations depending on which area of the spine is affected. If the bulging or herniated disc is located in the cervical spine, the patient can experience symptoms in the neck, upper back, shoulders, arms, and/or hands. Compression of a nerve in the lumbar spine can lead to discomfort in the lower back, hips, buttocks, legs, and/or feet.

Nonsurgical TreatmentsOnce being diagnosed with degenerative disc disease in the back, most patients’ physicians will recommend a regimen of conservative, nonsurgical treatments. This is likely to include the use of over-the-counter medication, namely nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics. NSAIDs, such as naproxen and ibuprofen, relieve pain and reduce inflammation by blocking the body’s production of certain enzymes. Those who suffer from cardiovascular or gastrointestinal conditions may be advised against taking NSAIDs and may, instead, be instructed to take analgesics like acetaminophen. Some physicians will occasionally prescribe muscle relaxants or narcotic pain relievers, but only after over-the-counter medications have proven ineffective. Many of those who suffer from degenerative disc disease in the back are instructed to make certain lifestyle changes, such as:

• Losing weight• Becoming more active• Quitting smoking• Reducing alcohol consumption

To ensure good health, patients should be sure to consult their physicians before partaking in any of these lifestyle changes.

Nonsurgical TreatmentsPhysicians also often recommend physical therapy for individuals who have been diagnosed with degenerative disc disease. This type of treatment can strengthen the muscles in the back and abdomen, which may provide the spine with additional support and relieve some of the strain that is placed on the intervertebral discs. Physical therapy may also entail the use of other treatment techniques, such as cryotherapy (cold therapy), thermotherapy (heat therapy), therapeutic ultrasound, transcutaneous electrical nerve stimulation (TENS), massage therapy, and posture modification exercises, among others. Alternative therapies are also becoming increasingly popular among patients who have degenerative disc disease in the back. Herbs and dietary supplements, acupuncture, hypnotism, and chiropractic manipulation have helped many individuals reduce their pain and increase their quality of life. That being said, many members of the medical community continue to eschew alternative therapies due to questions regarding their efficacy and credibility.

Surgical TreatmentThose patients who find conservative treatments to be ineffective after several weeks or months may be advised to consider undergoing surgery for degenerative disc disease in the back. It may prove beneficial for these patients to ask their physicians if they are candidates for a minimally invasive procedure in lieu of open spine surgery. These procedures are usually performed on an outpatient basis and typically require a much briefer and less demanding rehabilitation. As an added benefit, minimally invasive procedures do not require spinal fusion, allowing patients to retain mobility throughout their necks and backs.

Before consenting to any surgical treatment, patients should make sure they’re comfortable with all associated risks and benefits. It may also be a good idea to receive a second or third opinion to make sure surgery is even warranted.