What is degenerative disc disease?

Understanding Degenerative Disc Disease

Degenerative disc disease (DDD) is a common condition that affects the spine's intervertebral discs, causing them to gradually deteriorate over time, which can lead to pain, stiffness, and potential nerve compression.

What Is Degenerative Disc Disease?

Degenerative disc disease is not actually a disease but a natural process that occurs as part of aging. It involves changes to the spine's discs that act as cushions between the vertebrae. These changes include:

• Loss of fluid in the discs, making them less flexible and thinner
• Small tears in the outer layer of the disc
• Loss of disc height and space between vertebrae
• Development of bone spurs (osteophytes)
• Narrowing of spaces where nerves exit the spine

Why Discs Degenerate

Several factors contribute to disc degeneration:

• Aging: The natural aging process causes discs to dry out and lose flexibility 1
• Genetics: Family history plays a significant role in determining who develops symptomatic DDD 2
• Mechanical stress: Repetitive movements, poor posture, and occupational factors can accelerate degeneration 2
• Imbalance of processes: An imbalance between breakdown (catabolic) and repair (anabolic) processes in the disc 3

The Degenerative Cascade

The widely accepted Kirkaldy-Willis model describes disc degeneration in three phases 1:

1. Dysfunction phase: Initial changes in the disc with minor symptoms
2. Instability phase: Progressive degeneration causing more movement between vertebrae
3. Stabilization phase: Formation of bone spurs and stiffening of the segment

Common Symptoms

Degenerative disc disease can cause:

• Pain in the affected area of the spine (most commonly low back or neck)
• Pain that worsens with certain movements or positions
• Pain that may radiate to arms or legs if nerves are compressed
• Numbness or tingling in extremities
• Muscle weakness in severe cases

Diagnosis

Imaging is typically not recommended for acute back pain without "red flags" (warning signs of serious conditions) 4. This is because:

• Many people without back pain have disc degeneration visible on imaging
• MRI shows abnormalities in a high percentage of asymptomatic individuals 4
• Imaging findings often correlate poorly with symptoms 4

When imaging is appropriate (typically after 6 weeks of persistent symptoms), options include:

• X-rays: Can show disc space narrowing and bone spurs
• MRI: Best for visualizing disc condition, nerve compression, and other soft tissue changes
• CT scan: Provides detailed images of bone structures

Treatment Options

Most cases of degenerative disc disease respond well to conservative treatment:

• Rest: Brief periods of rest during acute pain episodes
• Physical therapy: Exercises to strengthen supporting muscles
• Medications: NSAIDs for pain and inflammation
• Activity modification: Learning proper body mechanics and avoiding aggravating positions
• Heat/cold therapy: To manage pain and inflammation

For persistent symptoms, additional options may include:

• Injection therapy: Epidural steroid injections for nerve pain
• Advanced pain management: For chronic pain that doesn't respond to other treatments
• Surgery: Reserved for severe cases with neurological symptoms or disabling pain that doesn't respond to conservative measures

Living With Degenerative Disc Disease

Most people with degenerative disc disease can manage their symptoms effectively with proper care:

• Maintain a healthy weight to reduce stress on the spine
• Practice good posture and body mechanics
• Stay physically active with appropriate exercises
• Avoid smoking, which can accelerate disc degeneration
• Learn pain management techniques

When to Seek Medical Attention

Consult a healthcare provider if you experience:

• Persistent back pain lasting more than a few weeks
• Pain radiating down your arms or legs
• Numbness, tingling, or weakness
• Difficulty with bladder or bowel control (a medical emergency)

Remember that while degenerative disc disease is a natural part of aging, severe pain is not inevitable, and effective treatments are available to help manage symptoms and maintain quality of life.