Degenerative Disc Disease (DDD) describes the wear and tear in the spine that nearly everyone experiences, with increasing age. It is not an actual disease, but rather a condition where damaged discs cause neck or back pain.
Magnetic resonance imaging (MRI) shows that most people over 60 years of age have some damage to their discs. However, not everyone has pain. In advanced cases, people may have pain and stiffness as the discs collapse, causing the surrounding (facet) joints to rub against each other.
Although DDD is not reversible or curable, the pain flareups that are associated with it can be treated. A pain specialist can offer you medications and pain-relief injections to control the pain.
What causes DDD?
Spinal disc wear-down (degeneration) causes DDD. It is a less common cause of neck/back pain, when compared to other disc injuries, such as “disc herniations”. Disc herniations cause the disc to bulge out of its normal place between the backbones or to break apart.
DDD starts with smaller problems, such as simple tears in the outer part of the disc or small changes in the center. In order to understand what causes DDD, let’s take a quick look at the “disc”.
Discs are water-filled shock absorbers that lie between your backbones. They allow bending, twisting, and stretching in the spine. In young people, discs are rubbery and flexible. As people age, discs begin to weaken and shrink. The makeup of a disc is similar to that of a jelly donut: it has a soft center and a tougher outer layer.
A disc has two parts:
- The soft, jellylike core can leak out after an injury, causing swelling and pain in your neck or back.
- The tough outer layer has many nerves. If a disc tears in this area, it can be quite painful.
What triggers DDD?
- Aging. As you age and experience repeated shocks to your spine, the discs lose their water content and dry out.
- Daily activities and sports. Repeated wear and tear from lifting, running, or twisting can tear the outer part of the disc.
- Poor blood supply. While other tissues receive a generous supply of blood and oxygen, the disc is a fibrous tissue that receives only a low supply. This means that a disc repair itself very slowly. It’s common for an injured disc to deteriorate, in a stepwise manner over the course of 20 to 30 years.
- Trauma. Sudden forces applied to the spine, such as can occur in a car accident, can injure the discs.
- Genetic predisposition. “Bad backs” may run in families. You may have a higher risk for DDD if a parent or grandparent also suffers from it.
- Weak core muscles. The abdominal muscles, pelvic muscles, and some muscles around the spine are collectively known as “core” muscles. They provide support to the spine. Core muscle weakness, (i.e. from prolonged hospital stays in bed) can lead to disc injuries.
How do I know if I have DDD?
DDD is commonly found in the neck and low back, but can occur anywhere along the spine. The neck and low back receive more strain with movement than other spine areas.
DDD symptoms in the neck:
- Neck pain that may shoot into the arms and hands
- Pain that ranges from mild and nagging to severe and disabling
- Numbness and tingling in the arms, hands, and fingers
- Severe pain that comes and goes; may last from a few days to a few months
DDD in the low back include:
- A dull ache and pressure across the low back and into the buttocks
- Pain that is worse when sitting, bending, lifting, or twisting
- An improvement in pain when walking and moving
- Decreased pain when changing positions often or when lying down
- Numbness and tingling in the legs
- Leg weakness or foot drop (a sign that a disc is pressing on a nerve)
Will DDD go away?
Unfortunately, DDD does not go away. Just like aging, once your discs begin to degenerate, you can’t reverse the process. However, the pain caused by DDD can be treated.
DDD pain may flare up for several days or a few weeks. In time, as the disc damage advances, flare-ups may become more frequent, and longer lasting. The pain may even become constant.
The good news is that DDD pain flareups often improve with time and treatment. There are many treatments a pain specialist can offer, that may prevent you from going to surgery.
When should I see a pain specialist?
You should see a pain specialist when your neck or back pain becomes moderate or severe. You should certainly visit your doctor if the pain starts to interfere with daily activities like walking, driving, or sleeping.
A pain specialist will diagnose the cause of your neck or back pain based on your medical history and a physical examination. Your doctor may order these diagnostic tests:
- X-rays (radiographs) show bone defects and are often used to rule out other causes of back pain, such as fractures.
- Imaging scans, such as CT and MRI to gather information about the state of the spinal nerves, the discs, and how they are aligned.
- A discogram involves injecting a dye into the soft center of the disc to see whether the disc is painful. The dye shows up on a CT scan or X-ray.
What is the right treatment for me?
One one hand, DDD treatment involves controlling the pain. On the other hand, it involves maintaining flexibility in the muscles that support the spine.
Early (conservative) treatment starts with:
- Over-the-counter medications treat mild-moderate pain. Nonsteroidal anti-inflammatory drugs (NSAID’s) like Ibuprofen (Advil), Aspirin and others, decrease inflammation and pain. For people who cannot take anti-inflammatories, acetaminophen (Tylenol) can help.
- Adjuvant medications are “helper” medications that are not pain-killers but can reduce pain through other mechanisms. Antidepressants like Duloxetine (Cymbalta) and Amitriptyline (Elavil) treat nerve pain (tingling and numbness in the arms or legs). Muscle relaxants like Cyclobenzaprine (Flexeril) calm the muscles around your painful back area.
Physical therapy improves your strength, flexibility, and range of motion. Back braces and hot/cold therapy may help, as well.
- Epidural Steroid Injections (ESIs) place steroids, and sometimes numbing medicine, near the discs. Steroids reduce inflammation. An ESI is a quick procedure, performed in a pain specialist’s office. While the pain relief is temporary, lasting for several days to months, it helps you to start physical therapy. Epidural injections can be repeated.
- Facet Joint Injections place steroid and/or numbing medicine in the facet joints that lie next to the damaged disc. When a disc dries out, the facet joints rub against each other, causing your neck or back pain. Facet joint injections can relieve pain over a period of several days to several weeks.
- Regenerative treatments use stem cells from your bone marrow and platelet-rich plasma (PRP) from your blood to treat aging and painful discs. These treatments can also treat pain due to bulging or herniated discs.
Advanced pain treatments
Spinal Cord Stimulation (SCS) can relieve pain in a significant number of patients with low back DDD. This therapy is used when your chronic pain does not improve with the treatments mentioned above. A small device is placed in your back. This device sends electrical signals to your spinal cord in order to stop the pain.
Invasive treatments – Surgery
Disc replacement is a surgery that replaces an unhealthy vertebral disc with an artificial disc made out of metal or plastic-like material. The artificial disc works like a normal disc – it carries load and allows movement.
Fusion is a common surgery for back pain, attempted when a joint cannot be salvaged. A surgeon unites the two bones that make up the joint into one solid bone. This may require placing “hardware” (metal rods and screws). While fusions may provide benefit, risks exist and in the long-term, as pain may return.
What can I do to improve?
- Don’t smoke. Smoking slows blood flow to the discs and slows healing.
- Strengthen core muscles. It helps support the spine and reduce strain on your discs.
- Exercise. Extra pounds put pressure on your spine and increase back pain.
- Eat well. A healthy diet helps you maintain a healthy weight; some foods (fish, berries) fight inflammation.
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