Degenerative disc disease (DDD) refers to the degeneration, or normal ‘wear and tear,’ of intervertebral discs. It is one of the most common causes of low back and neck pain. Degenerative disc disease is a natural process that affects all individuals, progressing with age.
With degenerative disc disease, the intervertebral disc itself becomes the source of pain; the degeneration that occurs in the disc leads to an inability to effectively distribute pressure through the spinal column and associated joints3. The development of symptoms is variable; some will experience significant pain while others will experience none. For those that do experience pain, a ‘degenerative cascade’ process has been described to explain the etiology of DDD. This process includes:
- Acute injury occurs to the disc
- The injury causes instability of the spine and inflammation, with intermittent bouts of pain
- With healing, the instability is corrected and fewer episodes of pain occur
Thus pain associated with degenerative disc disease is thought to be caused by inflammatory compression of discs and instability of spinal discs leading to reflexive spasm of associated muscles1. This pain tends to be intermittent, flaring up from a base line level of low/no pain. As instability heals, however, pain generally improves with time. If pain is continuous and/or severe, alternative pathology other than degenerative disc disease needs to be considered1,3.
Other symptoms associated with degenerative disc disease include numbness, tingling, and radiation of referred pain into the extremities1,3. If these symptoms get worse, or weakness develops, it is possible that the degenerative disc disease has progressed into a disc herniation, compressing and possibly damaging nearby nerve roots.
Diagnosis and Treatment
Diagnosis of degenerative disc disease is only made by excluding other possible causes. The diagnosis is made by a doctor via history, physical exam, and through imaging studies such as magnetic resonance imaging (MRI). An MRI cannot diagnose degenerative disc disease alone as some individuals may experience pain with no radiologic findings while others may have evidence of disc degeneration yet experience no symptoms. Radiologic findings must be compared with a history and physical exam performed by the physician1,2.
- Most patients can be treated with conservative management including2,4:
- Activity modification and exercise, such as core strengthening and aerobic conditioning
- Medications such as acetaminophen (Tylenol™) or ibuprofen (Advil™) can be used to manage mild chronic pain
- Opioids like codeine can be prescribed for the short-term relief of more severe pain
- Physical therapy that includes therapeutic exercise, gentle stretching, electrical stimulation, traction, and more can be beneficial
- Heat and ice can be used at the site of pain to relieve inflammation
If conservative treatments fail, a variety of surgical treatment options exist for degenerative disc disease2:
- Spinal fusion of the vertebrae around an affected disc to restrict joint motion (dynamic stabilization is similar to fusion, but uses more flexible materials as an internal brace)
- Disc arthroplasty, or artificial disc replacement
- Nucleoplasty, or removal of disc material
Approximately 65% of individuals will experience improvement following surgical intervention2. Further, post-operative pain and stiffness may prevent a full return to pre-operative activity levels.
References:
- Ullrich, P.F. (2005) What is degenerative disc disease? Spine-Health. Retrieved from www.spine-health.com/conditions/degenerative-disc-disease.
- Williams, K.D.; Park, A.L. (2007). Degenerative Disc Disease and Internal Disc Derangement. Campbell’s Operative Orthopaedics, 11th Ed. MD Consult Web site, Core Collection. Retrieved from www.mdconsult.com.ezproxy2.library.arizona.edu/books
- Isaac, Z.; Anderson, B.C. (2011). Evaluation of the patient with neck pain and cervical spine disorders. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
- Anderson, B.; Isaac, Z.; Devine, J. (2010). Treatment of neck pain. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA.
