What Is Degenerative Disc Disease?The spinal column is composed of small bones called vertebrae that interlock to form a canal through which the spinal cord may travel. The larger part of one of these bones holds a disc-shaped piece of cartilage in order to cushion and stabilize the vertebra above it. These discs, known as intervertebral discs, act as the shock absorbers for, and main support of, the spine. However, the degeneration (or gradual wearing-through over time) of one or more of these discs may lead to changes in the alignment of the spine and possible pain. This is known as degenerative disc disease, which is mostly associated with advanced age.
Degenerative disc disease is associated with some other conditions, including:
- Osteoarthritis: This is a chronic degeneration of cartilage. Without this material, the bones within joints may come into direct contact with one another, which may result in damage and pain.
- Disc herniation: This is a condition in which an intervertebral disc may bulge outward or break in two. This is also related to age-related degeneration.
- Spinal stenosis: This refers to a narrowing (stenosis) of the spinal canal, resulting in the compression of the spinal cord. This may be associated with chronic pain or neurological symptoms.
Degenerative disc disease may cause pain felt in many parts of the back. This pain may increase in response to movement. This condition may also be associated with many different types of pain. Some patients report their pain as being felt over a wide area, whereas others may feel a concentrated sharp pain in one small area. Degenerative disc disease may cause other effects, such as a loss of normal sensory or motor abilities. Pain associated with this condition may be centered in the back or also spread out into the extremities.
Causes Of Degenerative Disc Disease
Much of the research into degenerative disc disease concluded that the condition is most likely related to simple wear and tear over time. However, some other scientists maintain that this cannot explain the degree of pain that can result from the condition. Disc degeneration may be associated with the release of inflammatory molecules that promote the perception of pain in small nerve fibers near a damaged disc. Worn-down discs may also lead to increased activity in some muscles near the spinal column, which may also contribute to pain.
The probability of developing degenerative disc disease may also be influenced by other factors. These include a history of smoking and genetics.
Treatments For Degenerative Disc DiseaseA number of treatments are offered to address degenerative disc disease. Some of these are surgical interventions, which are normally reserved for cases presenting with severe pain or other symptoms.
Patients experiencing mild to moderate pain may consider physical therapy as a first-line treatment. This option usually comprises a program of stretches, low-impact exercise, and specific conditioning. It has demonstrated some efficacy for this condition. The application of alternate hot and cold compresses is another conventional therapy for degenerative disc disease.
Some other non-medical therapies may have some benefit for patients with mild to moderate pain. These include acupuncture, which is a procedure in which thin needles are inserted into various body parts to promote the release of endorphins. This has been shown to have some effect in painful conditions such as degenerative disc disease.
Patients with degenerative disc disease may also consider conventional drug therapy, or over-the-counter medications. Non-steroidal anti-inflammatory drugs (NSAIDs) are common painkillers, such as ibuprofen. These reduce inflammation and treat mild to moderate pain. Oral corticosteroids also reduce inflammation, and may be an effective option for patients without severe pain.
However, some patients may find their pain is too intense for these measures to be effective. In these cases, opioid therapy may be an option. Opioids are drugs such as morphine and codeine that can significantly reduce the perception of pain. These drugs are most often prescribed for severe pain with sudden onset. However, long-term opioid use is linked to the increased probability of risks such as tolerance and addiction. Therefore, the treatment of chronic pain with opioids should be approached with caution.
Patients whose degenerative disc disease is accompanied with severe pain may consider other treatments as well. Epidural steroid injections involve the injection of steroid medications into a space between the vertebrae and spinal cord. This is associated with effective pain relief in conditions such as degenerative disc disease.
Spinal cord stimulation is a procedure in which a device that modulates pain signals to the brain is implanted near the spinal cord. This device is connected to a hand-held controller that the patient may activate in response to pain. Spinal cord stimulation has been shown to be effective in treating chronic pain conditions in the long term.
Some cases of degenerative disc disease may result in severely damaged intervertebral disc material, causing severe chronic pain, numbness, or loss of motion. This may occur in conjunction with disc herniation, in which the outer part of the disc may rupture. This may be confirmed through discography, in which discs suspected of extensive damage are injected with contrast material, which is visualized with X-ray or computed tomography techniques.
If this test proves positive, these parts of the disc may need to be surgically removed. Procedures that may be used to achieve this include a discectomy, in which the abnormal disc material is removed. This may be done in conjunction with disc decompression, which reduces the chances of damage to surrounding nerve tissue.
Degenerative disc disease is thought to be related to the wear and tear of the intervertebral discs of the spine over time. Some researchers conclude that pain and damage to disc material is associated with excess inflammation in this tissue. Many therapies may address the symptoms of this condition. Common first-line treatments include oral painkillers and physical therapy. Patients with more severe pain that is resistant to these may consider epidural steroid injections. Surgical interventions to remove disc material should be reserved for advanced cases in which sensory and motor deficits are present.
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