Can you tell me what degenerative disc disease is? My mother just called and said this is what she's been diagnosed with. Is this a learn-to-live-with-it kind of condition? Or can something be done to ease her pain?
The discs are located between the vertebrae and act as shock absorbers. They are made up of two parts. The inner nucleus is a gel-like substance. The outer fibrous covering is called the annulus.
As we get older, we lose fluid from the annulus. The discs become dry and brittle. The collagen fibers in the annulus start to break down. The annulus can crack and form fissures. Chemicals leak out from the center. These chemicals irritate the spinal nerve roots and cause discogenic pain. The patient is diagnosed with degenerative disc disease (DDD).
Low back pain that comes and goes is often the first symptom of DDD. Sitting or standing seems to make it worse. Lying down can make it better. Some patients have LBP that goes down the leg. This is called sciatica. It is caused by pressure on the sciatic nerve.
Early on, the disc has some limited ability to heal itself so the symptoms go away. But over time and with repetitive motion and overloading, the disc degeneration continues. When the pain becomes constant, then many people seek medical help.
Treatment may begin with nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs reduce inflammation but also act as a pain reliever. Chiropractic or Physical Therapy care may be helpful as well.
Surgery may be needed for patients who have had disabling pain despite conservative measures. Progressive neurologic symptoms such as increasing numbness, weakness, and muscle atrophy point to the need for surgery. The surgeon may perform a discectomy (disc removal).
It's possible now to have a partial or complete discectomy using minimally invasive techniques. The surgeon inserts a long thin instrument into the spine that allows him or her to see inside the spinal segment. The procedure can be done without a large incision.
A nucleoplasty can also be done this way. In this case, the surgeon only removes loose fragments of the disc in the intervertebral space. The disc is not punctured or entered at all.
Your mother may be a candidate for one of these procedures. But a three to six-month course of conservative care is usually advised first.
Pierce D. Nunley, MD, et al. Intradiscal Electrothermal Therapy (IDET) for Low Back Pain in Worker's Compensation Patients. Can It Provide a Potential Answer? Long-Term Results. In Journal of Spinal Disorders & Techniques. February 2008. Vol. 21. No. 1. Pp. 11-18.
