Degenerative disc
Overview | Causes | Symptoms | Diagnosis | Treatment | FAQ
Degenerative disc disease commonly occurs with age, as discs become more
brittle, less resilient and more prone to herniation. Degenerative disc
disease is the single most common diagnosis related to serious back and
neck pain. When a disc herniates in the spine, the surgeon can sometimes
simply remove a portion of the disc. In other cases, where the disc is
more damaged and must be removed, something must be placed into the disc
space. Otherwise, the two vertebrae will collapse on top of one another,
placing pressure on the nerve roots that branch off from the spinal cord.
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Some of the contributing factors of degenerative disc disease are family
history, lifestyle and age. The prime age for disc-related problems
is after 35. If a parent had back or neck surgery for a herniated
disc, you should be particularly concerned about taking care of your
back. Lifestyle is another important factor. Those who perform frequent
lifting or put themselves in situations where the spine is exposed
to trauma or repetitive shock can also develop degenerative discs
over time.
Osteoporosis can lead to disc degeneration. As bones
weaken, a person becomes increasingly at risk for vertebral fractures.
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Degenerative disc disease makes the back more prone to injury and can
contribute to the following conditions:
-
Back pain
-
Neck pain
-
Hunched over appearance
-
Herniated disc
-
Vertebral fractures
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Outlined below are some of the diagnostic tools that your physician
may use to gain insight into your condition and determine the best
treatment plan for your condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your back
and neck pain which can help outline the most appropriate treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic testing
methods. X-rays show bones and the space between bones. They are
of limited value, however, since they do not show muscles and ligaments.
MRI (magnetic resonance imaging) uses a magnetic field
and radio waves to generate highly detailed pictures of the inside
of your body. Since X-rays only show bones, MRIs are needed to visualize
soft tissues like discs in the spine. This type of imaging is very
safe and usually pain-free.
CT scan/myelogram: A CT scan is similar to an MRI
in that it provides diagnostic information about the internal structures
of the spine. A myelogram is used to diagnose a bulging disc, tumor,
or changes in the bones surrounding the spinal cord or nerves. A
local anesthetic is injected into the low back to numb the area.
A lumbar puncture (spinal tap) is then performed. A dye is injected
into the spinal canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup.
These tests, called electromyography (EMG) or somato sensory evoked
potentials (SSEP), assist your doctor in understanding how your nerves
or spinal cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton.
Bone scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan are
performed to view the disc composition to determine if its structure
is normal or abnormal. In addition to the disc appearance, your doctor
will note any pain associated with this injection. The benefit of
a discogram is that it enables the physician to confirm the disc
level that is causing your pain. This ensures that surgery will be
more successful and reduces the risk of operating on the wrong disc.
Injections: Pain-relieving injections can relieve
back pain and give the physician important information about your
problem, as well as provide a bridge therapy.
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 A typical solution for problems related to DDD is a spinal
fusion procedure.The main problem with fusion surgeries is that
they don't often turn out well. While some studies claim a success
rate of about 75 percent, that still leaves one in four surgeries as
not successful. The second problem with fusion surgery is that there
is a reduction in mobility that can cause other problems over time.
Because the fusion locks a vertebral segment from rotating, it causes more stress on the level above and below the fused site, which in turn can herniate the other discs. Thankfully, there is an alternative today—artificial
disc implantation.
Dietary supplements or medications may be recommended
to treat degenerative disc disease that is linked to osteoporosis.
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What is degenerative disc disease?
A natural byproduct of aging is the loss of resiliency in spinal discs
and a greater tendency for them to herniate, especially when placed
under a weighty load, like when we lift heavy objects. Additionally,
some people have a family history of degenerative disc disease, which
increases their own risk of developing it. When a natural disc herniates
or becomes badly degenerated, it loses its shock-absorbing ability,
which can narrow the space between vertebrae.
 Who is a candidate for the artificial
disc?
Patients with a diseased disc between L4 and L5 or between L5 and S1
(all in the lower back) that is worn out or become injured and causes
back pain are candidates for the artificial disc. Other candidates
include those with degenerative disc disease (DDD) whose bones (vertebrae)
have moved less than 3mm. Your physician will help you determine whether
or not the artificial disc is a good choice for you. Factors that will
be considered include your activity level, weight, occupation and allergies.
What are the benefits of the artificial
disc?
Generally speaking, those who receive artificial disc replacements
return to activity sooner than traditional fusion patients. Also, because
there is no need to harvest bone from the patient’s hip, there
is no discomfort or recovery associated with a second incision site.
Some of the overall benefits of artificial disc surgery include:
- Retains movement and stability of the spine
- Prevents degeneration of surrounding segments
- No bone graft required
- Quicker recovery and return to work
- Less invasive and painful than a fusion
- Reduces pain associated with disc disease
 While the artificial disc may well be a promising new
technology, most spine surgeons today are very cautious. There are
many serious concerns including:
- Constantly changing technology as new discs are coming
out that last longer and may be easier to insert and remove
- The lifespan of the implants are in question
- What happens if the implant needs to be removed
Consult with your spine surgeon to determine your best
option. Click here to
learn more about the artificial disc.
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