Disc Degenerative Disease
Degenerative disc disease (DDD) is a part of natural process of aging and to a certain degree this process happens to everyone.
DDD causes the soft gel-like center of the disc, called the nucleus pulposus, to start drying out. As a result the disc cannot hold the vertebral segment together as well as it used to. As the intervertebral discs shrink, the space between the vertebras available for the nerve roots also shrinks. At the same time the ligaments that surround the disc, called the annulus fibrosis, become brittle and they are more easily torn.
The intervertebral disc does not have a good blood supply and therefore cannot treat itself as all other parts of the human body do and therefore painful symptoms of DDD usually become chronic.
DDD is a disorder that may cause a back pain.
However, DDD does not necessarily lead to the spine-related pain. It is significantly proved that approximately 30% of patients with diagnosed signs of DDD have no pain symptoms. It must therefore be assumed that not all degenerated discs are pain generators.
When DDD becomes painful, it can cause different symptoms like pain, radiculopathy, or weakness. These symptoms are caused by the fact that discs between the vertebral bodies start to wear out combined with the inflammatory proteins inside the disc that become exposed and irritate the local area. Spine becomes less flexible and people complain of stiffness, especially towards the end of the day. The stresses of all the above changes causes the ligaments and facet joints to enlarge (hypertrophy) as they try to compensate and spread the load over a larger area. This over-growth causes the spinal canal to narrow, which can compress the spinal cord and nerves causing pain too.
Many people think that DDD will cause more pain as they get older. But it is common for people to have signs of DDD without pain by the time they reach 60s because the intervertebral disc has often degenerated to the point that it causes less pain.
A fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position. While many people over the age of 60 have degenerated discs, it is very rare for them to suffer from DDD.
For most patients suffering from DDD, conservative treatment is the first and usually most successful action. Conservative care options include:
Medications – help to relieve the pain and inflammation;
Exercises - improve flexibility of the trunk muscles and help to widen the intervertebral foramen(small canals through which the nerve roots exit the spinal cord);
Manipulative treatment - helps to increase spinal flexibility;
Physiotherapy - helps to relive the pain syndrome;
For people who are unable to function because of the pain, or who are frustrated with their activity limitations, surgery is an option.
Fusion surgery works because it stops the motion at a painful motion segment of the spine. However, the long-term effectiveness of surgical treatment for DDD as opposed to natural history, conservative treatment, or placebo has yet to be studied and fully understood.