Degenerative Disc Disease

Degenerative Disc Disease, What is it?

What can cause it, what are the treatment options and what should I expect. Spinal Anatomy a quick review. The inter-vertebral disc is composed of cartilage tissue between two spinal vertebra. It serves as a cushion separating two bone. The outer strong fibers are  called the annulus with a nucleus of gelatinous material in the center. Mechanically the discs function as the “shock absorbers” for the spine. There are 23 discs in human spine,  There are 23 discs in the human spine: 6 in the neck (cervical region), 12 in the middle back (thoracic region), and 5 in the lower back (lumbar region). In human’s formative years the disc due to a combination of fluid material and crossing outer ligament fibers,  has a well defined shape. With the passage of time disc material begins a process of degeneration.

Disc Terminology (1)

Normal (excluding aging changes)

Congenital/developmental variants

Degenerative/traumatic lesion

Annular tear

Herniation

Protrusion/extrusion

Degenerative Disc Disease

Research has shown that genetics, coupled with  wear and tear as well the aging process leads to gradual deterioration of the spinal vertebral and inter-vertebral  disc structures. As humans age there is a gradual drying out of intra-disc fluid or thinning of the disc. The vertebral facet joints also are affected by the process of aging.   When there is associated PAIN the condition is called Degenerative Disc Disease  (DDD). The type of pain includes lumbar, cervical or thoracic pain, leg pain (sciatica), pain radiating into the arm or hand.  Respectively there may also be associated numbness or tingling into the foot/toes or  hand/ fingers. The types of  pain that occurs from prolonged sitting, or repetitive bending or twisting or from long walks are associated with DDD.

How is a Diagnosis of Degenerative Disc Disease Made? 

Health care providers including chiropractor, osteopaths, and  allopathic doctors, rely on the taking of an appropriate history, clinical exam tests, coupled with findings on  x-ray, CT scan,  MRI and nerve conduction tests  to provide the  necessary positive findings to offer an appropriate diagnosis.

 Treatment  Options

Patients should rely on conservative care as a first choice option.  Conservative care includes instruction in proper body mechanics, education in exercises including , Flexion (See Williams type) , or extension  (see McKenzie).  Yoga has also been shown helpful for some class of patients. Treatment options should include spinal manipulation (SMT)  by  a respected chiropractor.  Science based studies has shown that SMT is safe and effective. Other  methods include  distraction methods . Over the counter medications  may be helpful. Acupuncture is also effective and provides relief. Is some cases time is  the best remedy.  Surgery or including spinal fusion should be considered as a  last resort medical procedure when all  conservative care has proven ineffective or failed.

1) Nomenclature and Classification of Lumbar Disc Pathology

Recommendations of the Combined Task Forces of the North

American Spine Society, American Society of Spine Radiology, and

American Society of Neuroradiology  by David F. Fardon, MD,* and Pierre C. Milette, MD†

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