What is Degenerative Disc Disease?
Degenerative disc disease (DDD) is a condition that affects the discs between the vertebrae of the spine. Despite its name, it is not a disease but rather a natural process that occurs as part of aging.
DDD involves the gradual breakdown of spinal discs over time. It commonly affects the lower back (lumbar spine) and neck (cervical spine) and can cause pain, weakness, and other symptoms, though not everyone experiences discomfort.
What Causes DDD?
Degenerative disc disease (DDD) is primarily caused by the natural aging process and wear and tear on the spinal discs over time. However, several factors contribute to its development and progression:
Main Causes
- Aging: As people age, their spinal discs naturally degenerate. This process typically starts after age 40, with almost 90% of people showing signs of disc degeneration by age 60
- Loss of fluid: With age, the discs lose water content, becoming thinner and less effective as shock absorbers
- Structural changes: Small tears or cracks develop in the outer layer of the disc, and the inner gelatinous material may seep through, causing bulging or herniated discs
Contributing Factors
- Genetics: Family history plays a role, as DDD can run in families. Scientists have identified several genes that may increase the risk.
- Daily activities: Repetitive motions and everyday tasks like lifting, bending, and twisting can contribute to disc degeneration over time
- Injuries: Even minor back injuries can accelerate the degenerative process
- Obesity: Excess weight, particularly around the midsection, stresses the spine and discs more.
- Occupation: Jobs involving heavy lifting or manual labour may increase the risk of disc degeneration.
- Smoking: Some studies suggest that smoking can increase the risk of DDD and potentially worsen existing conditions.
It’s important to note that while these factors can contribute to disc degeneration, the condition primarily results from the natural aging process. The intervertebral discs have limited blood supply, so they can’t quickly repair themselves once damaged.
This lack of regenerative ability contributes to the progressive nature of degenerative disc disease.
Symptoms of Degenerative Disc Disease
The symptoms of Degenerative Disc Disease (DDD) can vary in intensity and location, but typically include:
Pain
- Low-grade, continuous pain around the affected disc that occasionally flares up into more severe pain
- Pain primarily affecting the lower back, which may extend to the legs and buttocks
- Pain that extends from the neck to the arms (if cervical discs are affected)
- Increased pain with activities involving bending, twisting, or lifting
Characteristics of Pain
- It may worsen when sitting or after twisting and bending
- It can come and go, lasting from a few days to several months
- Often feels better with walking, changing positions, or lying down
Additional Symptoms
- Weakness in leg muscles
- Numbness or tingling in arms and legs
- A “giving out” sensation in the neck or back due to spinal instability
- Muscle tension or spasms
- Possible radiating pain that feels sharp, stabbing, or hot
Location-Specific Symptoms
Lumbar DDD (Lower Back)
- Mechanical back pain
- Buttock and hip pain
- Leg pain
- Burning, numbness, and tingling
- Possible loss of balance or bladder/bowel control
Cervical DDD (Neck)
- Mechanical neck pain
- Suboccipital headaches
- Shoulder and arm pain
- Burning, numbness, and tingling
- Possible loss of coordination
It’s important to note that the severity of symptoms doesn’t necessarily correlate with the extent of disc degeneration visible on imaging tests.
Some people with significant disc degeneration may experience minimal pain, while others with minor degeneration can have severe symptoms.
How is Degenerative Disc Disease treated?
Degenerative Disc Disease (DDD) can be treated through various approaches, ranging from conservative methods to surgical interventions. The treatment plan typically depends on the severity of symptoms and the patient’s overall health. Here’s an overview of the common treatment options:
Conservative Treatments
Medications
- Over-the-counter pain relievers (e.g., ibuprofen, aspirin)
- Prescription pain medications for severe cases
- Muscle relaxants for associated muscle spasms
Physical Therapy
- Specific exercises to strengthen back and core muscles
- Stretching routines to improve flexibility
- Posture correction techniques
Lifestyle Modifications
- Weight loss to reduce stress on the spine
- Smoking cessation to improve disc health
- Ergonomic adjustments at work and home
Heat and Cold Therapy
- Cold packs to reduce inflammation
- Heat therapy to improve blood flow and relax muscles
Alternative Therapies
- Massage therapy
- Chiropractic care
- Acupuncture
Minimally Invasive Treatments
- Epidural Steroid Injections: To reduce inflammation and pain around affected nerves
- Radiofrequency Neurotomy: Uses radio waves to destroy nerve tissues, causing pain
- Transcutaneous Electrical Nerve Stimulation (TENS): Delivers small electrical impulses to help ease pain
Surgical Options
Considered when conservative treatments fail to provide relief:
- Spinal Fusion: Connects vertebrae to stabilize the spine and reduce pain
- Artificial Disc Replacement: Replaces the damaged disc with an artificial one
- Discectomy: Removes part of the damaged disc to relieve pressure on nerves
- Foraminotomy, Laminotomy, or Laminectomy: Procedures to remove bone and create space for nerves
It’s important to note that treatment typically begins with conservative approaches, progressing to more invasive options only if necessary. The goal is to manage pain, improve function, and prevent further degeneration.
Most patients can effectively manage their symptoms with non-surgical treatments, while surgery is reserved for severe cases or those with neurological deficits.
Dr Clem Bonney & Degenerative Disc Disease
Dr Clem Bonney can assist with this common problem. This may include medications, physical therapies, advice, and occasionally referrals for intervention. Dr Bonney, in his role as an Occupational Physician, can provide advice to workers and employers about workplace modifications and risk management to keep workers engaged in the workplace.