Degenerative disc disease (DDD) is a medical term used to describe the gradual, natural breakdown of intervertebral discs separating the bones of the spine. These gel-like “shock absorbers” provide a cushion between the vertebrae and give the spine its flexibility and mobility.
When the fluid-filled discs begin to wear away as you approach or pass the age of 40, you may find yourself experiencing symptoms or side effects like neck and lower back pain, herniated discs, osteoarthritis, spinal stenosis, or nerve impingement, inflammation, or damage. Some of these conditions are merely annoying, whereas others may affect your function, causing tingling or loss of feeling in the hands or feet.
Eventually, some degree of disc degeneration will happen to most of us. According to The Arthritis Foundation, nearly everyone over the age of 60 has some form of degeneration of the spine.
Certain inherited conditions, lifestyle factors (like obesity), and traumatic incidents may bring about an earlier onset of degeneration (or a greater severity), but sooner or later most adults will experience this condition.
However, the fact that degenerative disc disease is inevitable doesn’t mean you can’t treat its symptoms and find some relief. Most people with DDD (and most physicians) would prefer to treat it conservatively, with lifestyle changes, self-care, exercise, and physical therapy. If these measures don’t help to ease pain and improve flexibility, you may need to see a specialist to discuss manipulation of the spine, medications, injections, or even surgery.
The following treatments are those most commonly recommended to people with DDD.
The most conservative way to treat lumbar pain or neck pain due to DDD is to use non-surgical, non-medicinal techniques or modalities. These include:
Certain medical support devices, either purchased from a pharmacy or prescribed by a physician, may help to ease the tension and physical forces that act on your spine.
Generally, supports such as braces should be worn for short durations only. Long-term use of a brace or collar may immobilize your spine for too long, restricting movement and leading to a weakening, shortening, or atrophying of your muscles (which will inevitably lead to more pain and dysfunction).
Such devices can include:
PT and some of the specific therapeutic modalities offered by physical therapists (and some orthopedic practices) is another option for managing pain and improving range of motion. Some PT strategies that may be effective include:
Some people with chronic back and neck pain from DDD get relief from manual manipulation by a chiropractor, osteopath, or massage therapist. Manipulation of the spine and surrounding tissue may help to take some of the pressure off nerves (for example, a chiropractic manipulation may help relieve sciatica symptoms).
Massage and manipulation may also help to:
These techniques can help with symptom management, but they are temporary and usually need to be repeated regularly.
Medication
If your pain is non-responsive to these methods, or if you’re in so much agony you can’t begin an exercise program, epidural steroid injections (with or without anesthetic) into the area round your facet joints may help.
An estimated half (50%) of patients who receive corticosteroid injections report significant relief of their pain symptoms.
Steroid injections are not a first-line approach. They’re not guaranteed to work and they can not be repeated often because shots administered to the same location over time can promote bleeding and bruising. Steroids can also have a negative effect on surrounding tissue. Doctors advise no more than three injections per year.
The last resort for many people is a surgery—in part because many people with disc degeneration are older and are hesitant to undergo unnecessary surgical procedures. However, today’s minimally invasive spinal surgeries are largely very safe.
Back or neck surgeries for disc degeneration include the following.
Spinal fusion. If your damage is significant, spinal fusion surgery can use screws and rods, and sometimes a bone graft, to fuse or join two or more damaged vertebrae. Fusion can add stability to a weakened back, allowing it to bear your weight without issue. It usually resolves pain issues, but it can leave you with less flexibility in that part of the spine. However, it’s a highly successful surgery and it can heal even more quickly with the additional of bone growth stimulator treatments, which are commonly recommended following the procedure.
Disc decompression surgeries. The type of decompression surgery your orthopedist recommends depends on what type of disc damage you’ve sustained and how it’s affected surrounding nerves and tissue. Some commonly performed cervical or lumbar decompression surgeries include:
Disc replacement surgeries. Artificial discs are now available to fully replace a damaged disc. While the procedure is relatively new and there are yet no long-term studies available, artificial disc replacement promises to retain more flexibility and motion over traditional procedures like spinal fusion.
Contact Coastal Orthopedics today with any questions about your diagnosis or treatment options for Degenerative Disc Disease at (361) 994-1166.
Article written by: Rob Williams, MD