From the Guidelines
Degenerative disk disease is a natural aging process that affects the spinal disks, causing pain and potential mobility issues, and should be managed with conservative approaches prioritizing pain management and lifestyle modifications. The condition is characterized by the gradual breakdown of spinal disks over time, leading to symptoms such as back or neck pain, stiffness, and radiating pain to arms or legs 1. It is essential to note that degenerative changes on lumbar imaging are usually considered nonspecific, as they correlate poorly with symptoms, and therefore, diagnosis should be based on a comprehensive clinical evaluation.
Symptoms and Diagnosis
Common symptoms of degenerative disk disease include:
- Back or neck pain that may radiate to arms or legs
- Pain that worsens with certain movements
- Stiffness
- Neurogenic claudication, which is characterized by symptoms of leg pain on walking or standing, relieved by sitting or spinal flexion, associated with spinal stenosis 1
- Radiculopathy, which is dysfunction of a nerve root associated with pain, sensory impairment, weakness, or diminished deep tendon reflexes in a nerve root distribution 1
Treatment and Management
Treatment for degenerative disk disease typically begins with conservative approaches, including:
- Over-the-counter pain medications like ibuprofen (400-800mg three times daily) or naproxen (220-500mg twice daily)
- Physical therapy focusing on core strengthening exercises
- Lifestyle modifications such as maintaining proper posture and weight management
- Heat and cold therapy to manage symptoms, with heat improving blood flow and cold reducing inflammation
- Brief individualized educational interventions, including education and a skills program, to help patients manage their condition 1
Surgical Options
In severe cases where conservative treatments fail, surgical options like spinal fusion or artificial disk replacement might be considered. However, surgery should be reserved for patients with severe symptoms and significant impairment in quality of life. It is crucial to prioritize conservative management and lifestyle modifications to minimize the risk of surgical complications and optimize patient outcomes. Factors like smoking, obesity, physical labor, and genetics can accelerate the degenerative process, and addressing these factors is essential in managing the condition 1.
From the Research
Definition and Characteristics of Degenerative Disk Disease
- Degenerative disk disease is an irreversible process characterized by a decrease in cell viability, attenuation of proteoglycan and type II collagen synthesis, and dehydration of nucleus pulposus 2
- It is a strong etiologic risk factor of chronic low back pain (LBP) 3
Treatment Options
- A multidisciplinary approach to treatment is often warranted, including patient education, medication, and cognitive behavioral therapies 3
- Surgical intervention with a rehabilitation regime is sometimes advocated 3
- Stem cell therapy specifically addresses the degenerative process and offers a potentially effective treatment modality 2
- Mesenchymal stem cells have the capacity to repair degenerative disks by differentiation toward chondrocyte-like cells, which produce proteoglycans and type II collagen 2
Effects of NSAID Use
- Non-steroidal anti-inflammatory drugs (NSAIDs) are a widely used treatment for low back pain (LBP) 4
- Oral indomethacin administration did not result in acceleration of intervertebral disc degeneration (IDD) in an in vivo rabbit model 4
- Histologic analysis was consistent with less severe disc degeneration in the group receiving indomethacin 4
- The glycosaminoglycan (GAG) content was higher in animals receiving indomethacin in both annulus fibrosus and NP at adjacent uninjured discs 4
Prognostic Factors and Future Research
- Prognostic factors related to the outcome of different treatments include maladaptive pain coping and genetics 3
- The identification of pain genes may assist in determining individuals susceptible to pain and in patient selection for appropriate therapy 3
- Future research is needed to ascertain long-term effects of indomethacin and other NSAIDs on disc matrix homeostasis 4
- Human cell therapy trials for degenerative disk disease are on the horizon, but potential issues might arise 2