The Degenerative Cascade
The normal intervertebral disc is composed of a nucleus pulposus at the center, surrounded by a fibrous ring known as annulus fibrosus. The nucleus pulposus is a soft, well hydrated, jelly-like substance that acts as a shock absorber.
What is Lumbar Degenerative Disc Disease?
Lumbar degenerative disc disease (DDD) is a common cause of lower back pain. Over time, these natural shock absorbers wear out and degenerate. Degenerative disc disease is not actually a disease but refers to the changes in the spine that occur as a part of the normal aging process.
Causes for Degenerative Disc Disease
Traumatic injury, aging, wear and tear, improper posture, repetitive movements, overuse, poor body mechanics and being overweight may alter the structure and function of the disc. Over time, the nucleus pulposus begins to dehydrate and become stiff, failing to provide shock absorption. This leads to a reduction in the disc height, exerting excess stress over the surrounding annulus fibrosis. The annulus gets damaged and can cause instability of the lumbar spine and pain. These structural changes can place abnormal stress on your lower back, causing pain.
Symptoms of Degenerative Disc Disease
You may be unaware of DDD and not experience any symptoms, and be informed of it on being examined for another health problem. However, when symptoms occur they develop gradually and worsen over time. You may experience lower back pain that radiates to the buttocks and legs, which may aggravate with movement. Other symptoms include tingling or numbness in your legs, or difficulty in walking, and rarely, loss of bowel and bladder control.
Diagnosis of Degenerative Disc Disease
Your physician will diagnose lumbar DDD depending on your symptoms, medical history, and a physical and neurological examination. Your reflexes are tested and any muscle weakness, loss of sensation or other signs of neurological injury are noted. Diagnostic imaging tests such as X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans may be used to confirm the diagnosis. X-rays of the spine are taken to identify the collapsed disc space. A CT or MRI scan may be used to reveal disc and endplate changes. A discography may be performed to confirm the diagnosis. Discography is a diagnostic procedure where a contrast dye is injected into the affected disc to determine the damage and source of pain.
Treatment of Degenerative Disc Disease
Treatment of lumbar DDD comprises of non-surgical and surgical treatment options. The non-surgical treatment options such as anti-inflammatory and pain medications, muscle relaxants, physical therapy, spinal injections, certain types of braces, and acupuncture may help relieve the pain and other associated symptoms. Your doctor may combine two or more treatment modalities to enhance the success of the treatment.
Surgery may be necessary if you have spinal instability, neurological dysfunction or persistent symptoms despite non-operative treatment. Spinal stabilization and fusion may be suggested to surgically treat lumbar DDD, which would help ease the pain and stabilize the spine.