Degenerative Disc Disease
What is degenerative disc disease?
Common degenerative disc disease questions
Degenerative disc disease is a misnomer
Disc degeneration is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.
Medical practitioners disagree on degenerative disc disease
While there is still a lot of debate in the medical community about degenerative disc disease, a few aspects of the condition are known. This article will discuss aspects of degenerative disc disease that are more commonly accepted, such as the theory of the degenerative cascade, as well as some areas of theory that are still a source of debate in the medical community.
Pain from degenerative disc disease
Low back pain from a degenerated disc
The lumbar disc has been likened to a jelly donut. It is comprised of a series of bands that form a tough outer layer and soft, jelly-like material contained within:
Source of the pain
The proteins in the disc space can cause a lot of inflammation, and inflammation in the disc space can lead to low back pain radiating to the hips. The associated pain can also travel down the back of the legs.
If the annulus—the outer rings of the intervertebral disc - becomes damaged or worn down, it is not as effective in resisting motion in the spine. This condition has been termed “micromotion” instability because it is usually not associated with gross instability (such as a slipped vertebral body or spondylolisthesis).
Both the inflammation and micromotion instability can cause muscular spasm in the low back. The muscle spasm is the body’s attempt to stabilize the low back. It is a reflex, and although the body’s response of muscle spasm is not necessary for the safety of the nerve roots, it can be quite painful.
The "degenerative cascade" of a degenerating disc
There is minimal blood supply to the disc, and blood is what brings healing nutrients and oxygen to damaged structures in the body. This means that the spinal disc lacks any significant reparative powers. Unlike muscles, which have good blood supply, once a spinal disc is injured it cannot repair itself.
Stages of degenerative disc disease
Based on the observation that demographic studies show less back pain from degenerative disc disease in elderly adults (over 60 years) than in younger adults (30 to 50 year-olds), he also concluded that this process happened over a period of 20 to 30 years. Although elderly patients may have pain from facet osteoarthritis, it is uncommon for them to have disc problems.
While this summary is a simplification of Kirkaldy-Willis’s extensive work, it lays the framework for what is known today. We do know that lumbar disc degeneration is a very common and natural process, and only in limited cases does it become painful.
Degenerative disc disease and low back pain
Many patients worry that if they are have a lot of low back pain when they are only 35 years old, the pain will become much worse and they may be in a wheelchair by the time they’re in their sixties. However, if patients can find a way to manage their back pain and maintain their function, the natural history is really quite favorable. With continued disc degeneration, all the inflammatory proteins within the disc space will eventually burn out, and the disc will usually become stiffer, thus decreasing micro-motion. In fact, someone who is 65 years old is actually less likely to have discogenic back pain than someone who is 35 years old.
Degenerative disc disease: the natural degenerative process
"Normal" disc degeneration with age
The proteins within the disc space also change composition, and most of us will develop tears into the annulus fibrosus (the outer hard core of the disc). Most people will have some level of disc degeneration by their sixth decade, yet most do not have back pain.
Magnetic Resonance Imaging (MRI scan) has contributed a great deal to our understanding of lumbar degenerative disc disease and the natural degenerative process. With the advent of MRI technology, good anatomic detail of the disc can be imaged and correlated with the individual’s back pain. Through studies with MRI scans, it was found that:
Therefore, degeneration on an MRI scan cannot be used as the sole diagnostic tool for lumbar degenerative disc disease. Disc degeneration present on an MRI scan is not synonymous with a diagnosis of degenerative disc disease and low back pain. The MRI findings need to be corroborated by the findings of the patient’s history and physical exam.
Pain from degenerative disc disease
MRI findings without significant degenerative disc disease
The cartilagenous end plate is the source of disc nutrition. If this becomes eroded, the disc is likely to go through a degenerative cascade leading to the inflammation and micromotion instability, which in turn causes pain. As it goes through the process, the disc space will collapse.
MRI findings of disc dehydration (often referred to as a dark disc, because a disc with less water in it looks dark on an MRI scan), annular tears, or disc bulges are not specific causes of low back pain. These findings may or may not be the cause of the patient’s low back pain. It is well known that the results of surgically fusing a spine with these findings will be much more unreliable than fusing a disc space that has disc space collapse and cartilagenous endplate erosion.
Common symptoms of degenerative disc disease
Along with MRI scan results that show disc degeneration, there are some common symptoms that are fairly consistent for people with low back pain from degenerative disc disease.
The typical individual with degenerative disc disease is an active and otherwise healthy person who is in their thirties or forties. In general, the patient’s pain should not be continuous and severe. If it is, then other diagnoses must be considered. Degenerative disc disease pain is usually more related to activity and will flare up at times but then return to a low grade pain level or the pain will go away entirely.
Common symptoms of degenerative disc disease include:
Types of pain from degenerative disc disease
The severe episodes of low back pain from degenerative disc disease will generally last from a few days to a few months before the patient goes back to their baseline level of chronic pain. The amount of chronic pain is quite variable and can range from a nagging level of irritation to severe and disabling pain, although severe, disabling pain is quite rare.
In addition to low back pain from degenerative disc disease, there may be
pain, numbness and tingling. Even without pressure on the nerve root (a
"pinched nerve"), other structures in the back can refer pain down the
rear and into the legs. The nerves can become sensitized with inflammation from
the proteins within the disc space and produce the sensation of
numbness/tingling. Generally, the pain does not go below the knee.
Chronic pain versus acute pain
In this manner, chronic pain is very different from acute pain. With acute pain, the severity of pain directly correlates to the level of tissue damage. This provides us with a protective reflex, such as the reflex to remove your hand immediately if you put it on something hot.
In chronic pain, the pain does not have the same meaning—it is not protective and does not mean there is any ongoing tissue damage.
Bottom Line: A disc doesn't get blood to help it heal, it needs movement, that is why exercise & stretching helps. That is also why Spinal Decompression helps because when you are stiff and hurting do you really stretch and exercise? No, you usually don't. Spinal decompression can help you manage your degenerative discs by imbibing the discs which brings health reviving extra-cellular fluid into the discs. Then as your pain gets under control or gone you can return to a program of self care to prevent further painful episodes.