Degenerative Disc Disease - Pain Management

Introduction

Your spine is made up of a series of bones.  Shock-absorbing pads, called discs, are located between each of the bones.  With age, the discs can begin to break down or deteriorate, and lead to a condition called degenerative disc disease.  The majority of people with degenerative disc disease are treated with pain management methods aimed at relieving discomfort and improving function.  In a small number of cases, surgery is used to correct structural abnormalities.

Anatomy

Causes

Degenerative disc disease can occur in any region of the spine; however, it most commonly occurs in the lumbar spine.  Doctors are not sure of the exact cause of degenerative disc disease, but it appears that aging, trauma, and arthritis contribute to this condition.  Doctors suspect that genetic, environmental, and autoimmune factors play a role as well.  Additionally, lifestyle factors, such as smoking, or strenuous repetitive activities, such as gymnastics or lifting, may lead to degenerative disc disease.  Degenerative disc disease develops most frequently in middle-aged or young adults with active lifestyles.

Physical changes in the disc occur with the natural aging process.  With advancing age, discs lose water content and become narrower, less flexible, and less effective as cushions between the vertebrae.  As a disc deteriorates, the outer layer can weaken and tear.  Discs heal slowly, during which time new nerve endings may form in the torn area.  Contact with the new nerve endings can cause irritation and pain.

A healthy disc acts as a cushion between the vertebrae.  However, when a disc degenerates, painful bone on bone rubbing can occur.  This can lead to changes in the spine structure that cause pain and impairs movement and function.

Without the protective disc, the spine can become structurally unstable and unable to tolerate stress, which may lead to other painful spine conditions including a herniated disc, spondylolisthesis, and spinal stenosis. A herniated disc occurs when the outer layer of the disc (annulus) ruptures and the inner contents (nucleus pulposus) comes out.  Pain, irritation, and swelling results when the inner contents contact the spinal cord or spinal nerves.  Spondylolisthesis is a spine condition that occurs when one vertebra shifts forward  out of place.  Spinal stenosis is a type of spine condition that results when the facet joints and ligaments enlarge, narrowing the space inside of the spinal canal. 

Symptoms

Degenerative disc disease may or may not cause symptoms.  If you have symptoms, pain in your neck or back may occur suddenly after an injury or start gradually and increase over time.  Your pain may be so intense that it interferes with your daily activities.  You may feel burning pain, pressure, numbness, weakness, or tingling.  Sitting may make your symptoms increase, whereas lying down may help to relieve pain.

The location of the degenerative disc in your spine may influence the type of symptoms that you have.  Degenerative discs in certain areas of the upper spine may have symptoms that spread to the arms.  Degenerative discs in the lumbar spine may have symptoms that spread to the legs.  In rare cases, the loss of bowel and bladder control accompanied by significant arm and leg weakness indicates a possible serious medical condition.  In this rare case, you should seek immediate medical attention.

Diagnosis

Your doctor can diagnose a degenerative disc by performing a physical examination and some tests.  Your doctor will ask you about your symptoms and medical history.  You will be asked to perform simple movements to help your doctor assess your muscle strength, joint motion, and stability.  Because the nerves from the spine travel to the body, your doctor will perform a neurological examination of your arms and legs to see how the nerves are functioning.

Your doctor will order X-rays to see the condition of the vertebrae in your spine.  Dye may be used to enhance the X-ray procedures in a procedure called a myelogram.  A mylegram is used to help determine if there is pressure on your spinal cord or nerves.

Additional imaging tests, such as a computed tomography (CT) scan, discogram, or magnetic resonance imaging (MRI) scan may be ordered.  A CT scan is useful for determining which disc is damaged.  A discogram is another type of imaging test that provides a view of the internal structure of a disc to help identify if it is a source of pain.  A discogram is usually immediately followed by a CT scan to show more detail about the extent of the rupture or tear pattern, as well as the size and shape of the disc. The MRI scan is the most sensitive imaging tool.  The MRI provides the most detailed images of the discs, ligaments, spinal cord, and nerve roots. 

Treatment

The majority of people with degenerative disc disease are treated with non-surgical methods aimed at pain relief and activity modification.  Over-the-counter medication or prescription medication may be used to ease your pain.  If your symptoms do not improve significantly with these medications, your doctor may inject your spine with corticosteroid medication to relieve pain at the source of the problem.

Your doctor may recommend that you wear a back or neck brace.  Occupational or physical therapists can provide treatments to help reduce your pain and any muscle spasms. The therapists will teach you exercises to help strengthen your back or neck muscles.

Non-surgical pain management treatments for degenerative disc disease are designed to relieve pain and restore function, but they cannot correct structural abnormalities in a disc or the spine.  For some people, surgery may be recommended if non-surgical treatments do not provide relief or if there is considerable loss of function.  Spinal fusion surgery is most frequently used for degenerative disc disease.  Spinal fusion surgery involves removing the degenerative disc and securing the vertebrae together.