Degenerative Disc Disease - Spine Degeneration
Degenerative Disc Disease is a condition that causes the intervertebral discs in the spine to deteriorate or break down. Intervertebral discs are the shock-absorbing pads located between your vertebrae. The vertebrae are the series of bones that make up your spine.
Degenerative Disc Disease can occur in any part of the spine. It develops more frequently in the lower back. Aging can cause the discs to lose fluid, collapse and sometimes rupture. This decreases the space between the vertebrae, which is why some people become shorter as they age. As the disc deteriorates, it affects the structure of the vertebrae. These changes can lead to conditions that put pressure on the spinal cord and nerves. Most symptoms of pain can be treated non-surgically. However, surgery is recommended if the spine is unstable or when pain cannot be relieved by other means.
The back part of each vertebra arches to form the lamina. The lamina creates a roof-like cover over the back opening in each vertebra. The opening in the center of each vertebra forms the spinal canal. Your spinal cord, nerves, and arteries travel through the protective spinal canal. The spinal cord and nerves send messages between your body and brain.
Intervertebral discs are located in between the cervical, thoracic, and lumbar vertebrae. The discs are made up of strong connective tissue. Their tough outer layer is called the annulus fibrosus. Their gel-like center is called the nucleus pulposus. A healthy disc contains about 80% water.
The discs and two small spinal facet joints connect one vertebra to the next. The discs and joints allow movement and provide stability. The discs also act as a shock-absorbing cushion to protect the vertebrae.
Normally, the intervertebral discs act as a cushion between the vertebrae. When a disc degenerates, painful bone on bone rubbing can occur. Abnormal bone growths, called spurs or osteophytes, can grow in the joint and enter the spinal canal. The bone spurs add to pain and swelling, while disrupting movement. The changes in spine structure can cause one vertebra to shift forward and out of place, a condition called Spondylolisthesis.
Without the disc to act as a cushion, the ligaments and facet joints on the vertebrae may enlarge to help compensate for the stress on the spine. The overgrowth can extend into the spinal canal causing it to narrow. The narrowed spinal canal can compress the spinal cord and nerves, resulting in pain and loss of function, a condition called Spinal Stenosis.
Degenerative Disc disease can also lead to a herniated disc. The outer disc layer, the annulus, can tear or rupture under stress. A herniated disc occurs when the annulus ruptures and the inner contents, the nucleus pulposus, comes out of the disc. When the inner contents come in contact with the spinal nerves they become irritated and swell, resulting in pain.
Degenerative Disc Disease can occur in any region of the spine. It most commonly occurs in the lumbar area. Doctors are not sure of the exact cause of Degenerative Disc Disease. It appears that the aging process, trauma, and arthritis contribute to the condition. Doctors suspect that genetic, environmental, and autoimmune factors play a role. Additionally, lifestyle factors, including smoking or strenuous repetitive activities, such as gymnastics or lifting, may contribute to disc degeneration as well. Degenerative Disc Disease develops most frequently in middle aged or young adults with active lifestyles.
Your doctor will order X-rays to see the condition of the vertebrae in your spine. Sometimes doctors inject dye into the spinal column to enhance the X-ray images in a procedure called a myelogram. A myelogram can indicate if there is pressure on your spinal cord or nerves from herniated discs, bone spurs, or tumors.
Your doctor may also order Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans to get a better view of your spinal structures. CT scans provide a view in layers, like the slices that make up a loaf of bread. The CT scan shows the shape and size of your spinal canal and the structures in and around it. A CT scan is useful for determining which disc is damaged. Your doctor may inject dye into the disc in a procedure called a discogram. A discogram provides a view of the internal structure of a disc and can help to identify if it is a source of pain. It is usually immediately followed by a CT scan. The MRI scan is very sensitive. It provides the most detailed images of the discs, ligaments, spinal cord, nerve roots, or tumors. X-rays, myelograms, CT scans, and MRI scans are painless procedures.
Your doctor may recommend that you rest and wear a back or neck brace. Occupational or physical therapists can provide treatments to reduce your pain, muscle spasms, and swelling. The therapists will also show you exercises to strengthen your back or neck muscles.
The type of surgery that you have will depend on the location of the degenerative disc in your spine and the extent of your condition. Spinal Fusion is the type of surgery most frequently used for degenerative disc disease. Spinal Fusion involves removing the degenerative disc and fusing or securing two or more vertebrae together to stop movement and relieve pain caused by movement. There are various techniques for spinal fusion surgery and the area of the spine that is involved determines the approach. Your doctor will let you know what to expect.
You will be sedated for the surgery. Your doctor will perform the surgery from the front or back of your spine, depending on the region of the spine that is affected. For a posterior surgery used for the lumbar region, your surgeon will make an incision on the middle of your spine. For an anterior surgery used for the cervical area, your surgeon will make an incision on the middle of your neck. Your muscles and other structures will be moved aside with care to allow access to the vertebrae. Your surgeon will remove all or part of the degenerative or herniated disc.
At the completion of your spinal fusion, your surgeon will close your incision with stitches. You will receive pain medication immediately following your surgery. You will wear a back or neck brace, depending on the location of your surgery, while your fusion heals.
You should expect to stay overnight or a few days in the hospital, depending on the type and location of your surgery. You may need a little help from another person during the first few days or weeks at home. If you do not have family members or a friend nearby, talk to your doctor about possible alternative arrangements.
Your doctor will initially restrict your activity level and body positioning. You should avoid lifting, housework, and yard-work until your doctor gives you the okay to do so. You will wear a neck or back brace for support. You will gradually increase your activity level. Once your fusion has healed, physical therapists will teach you strengthening exercises. You will also learn body mechanics, proper postures for your spine, to use when you stand, sit, sleep, and lift objects.