Degenerative Disc Disease – Spine Degeneration

The spine consists of a series of bones known as vertebrae, organized into distinct regions based on curvature and function. The cervical spine, located in the neck, is made up of seven small vertebrae. The thoracic spine, found in the chest area, contains 12 vertebrae, while the lumbar spine, situated around and below the waist, comprises five larger vertebrae. The lower vertebrae are either fused or shaped differently to connect with the hip and pelvic bones.

Each vertebra features a back arch known as the lamina, which creates a protective cover over the spinal canal. This canal houses the spinal cord, nerves, and arteries, serving as a crucial conduit for messages between the brain and body.

Intervertebral discs, made of robust connective tissue, are positioned between the cervical, thoracic, and lumbar vertebrae. The discs consist of a tough outer layer called the annulus fibrosus and a gel-like center known as the nucleus pulposus, which contains approximately 80% water. These discs, along with small spinal facet joints, facilitate movement, stability, and act as shock absorbers to safeguard the vertebrae.

As we age, the intervertebral discs naturally lose moisture, leading to decreased flexibility and height. Injuries to the discs, compounded by their lack of blood supply for self-repair, can result in deterioration. This degeneration may compromise the structural integrity of the spine, increasing the likelihood of other complications.

Typically, the discs cushion the vertebrae, but degeneration can cause painful bone-on-bone friction. Abnormal bone growths, or osteophytes, may develop in the joints and encroach upon the spinal canal, leading to pain and swelling that hinder movement. Changes in spinal structure can also result in conditions like Spondylolisthesis, where a vertebra slips out of place.

In the absence of a healthy disc, ligaments and facet joints may enlarge to compensate for spinal stress. This overgrowth can narrow the spinal canal, compressing the spinal cord and nerves, which may result in conditions like Spinal Stenosis.

DDD can occur in any region of the spine, but it is most prevalent in the lumbar area. While the precise cause of DDD remains unclear, factors such as aging, trauma, and arthritis are believed to contribute. Genetic, environmental, and autoimmune elements may also play a role, along with lifestyle factors like smoking and repetitive physical activities, which can accelerate disc degeneration. DDD is commonly observed in middle-aged or young adults leading active lifestyles.

Degenerative Disc Disease may present with various symptoms or none at all. When symptoms do occur, individuals may experience different types of back or neck pain, ranging from sudden onset following an injury to gradual pain escalation over time. This pain can be so severe that it disrupts daily activities, manifesting as burning sensations, pressure, numbness, or tingling. Symptoms may worsen with prolonged sitting but improve when lying down.

Depending on the location of the affected disc, pain may radiate to the arms or legs. In rare instances, the loss of bowel and bladder control accompanied by significant weakness in the arms and legs may indicate a serious medical issue, necessitating immediate medical attention.

To diagnose Degenerative Disc Disease, healthcare providers conduct physical examinations and review medical imaging. Patients will typically discuss their symptoms and medical history, and perform basic movements to evaluate muscle strength, joint motion, and stability. A neurological examination may also be performed to assess nerve function in the arms and legs.

Doctors often order X-rays to evaluate the condition of the vertebrae. In some cases, a myelogram, which involves injecting dye into the spinal column, may be performed to better visualize potential pressure on the spinal cord or nerves caused by herniated discs, bone spurs, or tumors.

Additionally, imaging techniques like Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans may be ordered for a more comprehensive view of the spinal structures. CT scans offer layered views, aiding in the identification of damaged discs, while MRI scans provide highly detailed images of the discs, ligaments, spinal cord, nerve roots, and tumors. All of these imaging procedures are painless.

The majority of individuals with Degenerative Disc Disease can find relief through non-surgical treatment options aimed at alleviating pain and adjusting activity levels. Over-the-counter or prescription medications may be utilized to manage discomfort. If symptoms persist despite medication, corticosteroid injections into the joint may be recommended as a relatively safe pain-relief option.

Resting and the use of back or neck braces may also be advised. Occupational or physical therapists can assist with treatments to alleviate pain, muscle spasms, and swelling, while providing exercises to strengthen back or neck muscles.

While non-surgical treatments focus on pain relief and functional restoration, they cannot rectify structural issues like spinal canal narrowing. Surgical intervention is considered when non-surgical methods yield minimal or no improvement. Surgery may also be indicated if a disc compresses a nerve or the spinal cord, leading to significant functional loss, or if there is progressive weakness in the legs accompanied by bladder and bowel issues.

The type of surgery performed depends on the degenerative disc's location and the severity of the condition. Spinal Fusion is the most common surgical procedure for DDD, involving the removal of the degenerative disc and the fusion of two or more vertebrae to alleviate movement-related pain. Various techniques exist for spinal fusion, and the approach will be determined by the affected spinal area.

The surgery requires sedation, and the surgeon may approach the spine from the front or back, based on the region involved. For lumbar surgery, an incision is made along the spine's midline, while cervical surgery requires an incision in the neck area. The surgeon carefully moves muscles and other structures aside to access the vertebrae, removing all or part of the degenerative or herniated disc.

A bone graft or interbody fusion cage is then placed in the empty disc space. The graft may consist of bone strips harvested from the patient's hip or allograft bone from a donor, and is positioned between the vertebrae. The surgical hardware—such as screws and plates in the neck or rods and screws in the lumbar area—secure the vertebrae together, facilitating the healing process.

Post-surgery, the incision is closed with stitches, and patients receive pain medication. Depending on the surgery's location, a back or neck brace may be required during the healing period.

Recovery from spinal surgery varies among individuals, influenced by the surgical type, affected spinal area, and the severity of the condition. Generally, recovery from cervical fusion takes four to six weeks, while lumbar fusion typically requires a longer healing period. Patients can expect to stay in the hospital for one or more nights, depending on the surgery.

Initially, activity restrictions and body positioning guidelines will be provided by the doctor. Patients should avoid lifting, household chores, and yard work until they receive medical clearance. Wearing a neck or back brace is essential for support, and activity levels will be gradually increased. After the fusion heals, physical therapists will guide patients through strengthening exercises and teach proper body mechanics and posture for daily activities.