The Basics of Degenerative Disc Disease (DDD)


Degenerative Disc Disease IlustrationEvery human has wear and tear of the body with age. The spinal disc are no exception. With aging, these discs lose elasticity and fluid, making them prone to various injury and damage. Degenerative disc disease (DDD) is the condition caused by damaged, worn discs of the spine.

Every year, 14% of doctor visits are for low back pain, and over 13 million visits are for chronic recurring back problems. Low back pain related to DDD affects men and women equally, and the condition affects young to middle-aged people more, with a peak incidence at around 40 years of age.

Symptoms of DDD

The spinal discs act as shock absorbers between the vertebrae (bones of the spine). Discs allow the back to stay flexible and bend through normal range of motion. The two portions of the disc are the annulus fibrosus and the nucleus pulposus. The annulus fibrosus is the outer layer that contains the nerves. If the disc tears in the annulus fibrosis, the patient will experience pain.

The soft, jelly-like center of the disc is the nucleus puposus. This material contains proteins that cause irritation and tenderness to any tissue they touch. When the nucleus leaks out, the proteins irritate nerves and surrounding tissue. With a DDD, many disc bulge or herniate, causing considerable back pain. Other symptoms of DDD include:

  • Pain that gets worse with lifting or bending
  • Pain that occurs when sitting and relieves with walkingchronic failed back pain
  • Back pain that radiates to the buttocks, thighs, or legs
  • Neck pain that radiates to the chest, shoulders, or arms
  • Numbness and tingling in the extremities
  • Weakness of the legs and/or feet

Causes of Degenerative Disc Disease

  • Lack of fluid – The disc should contain 80% water, but with age, it dries out.
  • Tears in the outer core – Wear and tear from activities can damage the outer layer of the disc.
  • Injuries – Any spine injury can lead to instability and soreness of the disc.

Diagnosis of DDD

A definitive diagnosis of DDD is made using x-rays and magnetic resonance imaging (MRI). However, the doctor will also take a history and conduct a physical examination. The doctor will ask you questions about what activities cause the pain in your back and extremities and check the affected area for range of motion and stiffness.

In addition, he/she will assess tender areas for nerve-related changes, such as change in reflexes and weakness. To confirm DDD, the doctor will rule out tumors, fractures, infections, and other conditions that cause back and extremity pain.

DDD Treatment Options

  • Medications – For mild cases of DDD, the doctor will recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen.

 

  • Epidural steroid injection (ESI) – The epidural is the layer of tissue outside of the spinal cord. The space is that which is between the layer and the cord. With the ESI, the doctor injects a long-acting steroid into the space. Most ESI is done using x-ray guidance.

 

  • Selective nerve root block (SNRB) – This procedure is used to diagnose the source of nerve root pain and to offer relief of back and/or leg pain. The doctor injects the nerve root with an anesthetic agent and possibly a steroid medication.

 

  • Lumbar sympathetic nerve block (LSNB) – With this procedure, the doctor injects a long-acting numbing agent near the sympathetic nerves. When a neurolytic substance is injected, such as phenol, it destroys the nerves and alleviates pain for a long time.

 

  • Stellate ganglion block (SGB) – For neck DDD, the doctor will inject the stellate ganglion, which is a collection of autonomic sympathetic nerves at the front upper region of the spine. An anesthetic and steroid combination is often used for this procedure.

 

Resources

Luo X, Pietrobon R, Sun SX. (2014). Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine, 29(1):79-86.

NCHS (2010). National Center for Health Statistics. Prevalence of Selected Impairment. Hyattsville, MD: US Department of Health and Human Services.

National Center for Health Statistics (1988). Vital statistics of the United States. Washington, DC: Government Printing Office; 1968-1988.