Lumbar Degenerative Disc Disease

By Spencer Schreckengaust
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Skeletal human spine and vertebral column or intervertebral discs on a dark background as a medical concept as a 3D illustration.

Lumbar Degenerative Disc Disease

In our society, approximately 85% of adults will experience low back discomfort over their lifetime, resulting in considerable health costs as well as personal economic costs.  One of the causes of low back pain can be lumbar degenerative disc disease (lumbar DDD).

Lumbar DDD explains the complex process of age-related changes that each person will experience as we age. So, if you have more than 50 candles on your birthday cake, you most likely have some signs of lumbar DDD. However, while radiographs will demonstrate signs of lumbar DDD, some individuals will be asymptomatic and others will exhibit significant symptoms.  For example, we tend to “shrink” because the water content in each disc will diminish and the disc height will decrease over time. This dehydration will cause a loss of shock absorption and integrity while putting more forces on other spinal elements.  Due to such biomechanical stresses, lumbar DDD are usually associated with other spinal conditions such as other spinal joint arthritis and sciatica.

Usually, persons with lumbar DDD will have pain at the center of the spine which can or cannot extend into the legs (possibly numbness, weakness), stiffness of the low back and increased discomfort with increasing spinal pressure like leaning forward, lifting heavy items or impact activities like running. 

If you are having symptoms related to lumbar DDD, conservative treatment options should be initiated first prior to any significant intervention such as epidural injections or surgical procedures.

If the following symptoms or “red flags” are present, please seek immediate medical attention: changes in bowel/bladder or sexual function, rapid unexplained weight loss, unchanging constant pain, drop foot in either leg, loss of balance, rapidly worsening condition, history of cancer, immunosuppression or osteoporosis.

Conservative treatment options include:

  1. Proper amount of rest during an acute episode. Now, this option DOES NOT mean bed rest from all activities but to be as active as possible without aggravating condition. For example, you should not go on your typical 45 minute walk but only walk for short time periods like 10 minutes if you do not have symptoms. Also, you can maybe ride a stationary bike with low resistance with a back support (recumbent bike) instead of walking.
  2. Usually, lying in a supine position (called 90-90 position) with your knees and hips at a 90 degree angle will offer relief as that position will place the lowest stress on the lumbar spine.
  3. Use non-pharmacological agents like moist heat or ice on your low back while in the 90-90 position mentioned above with proper layers of cloth to maintain your skin integrity and health.
  4. Potentially use NSAIDs or other anti-inflammatory medications as directed by your physician.
  5. Exercises: Initially, you should perform gentle flexibility and stretching exercises for the low back and legs while later incorporating strengthening of the lumbar spine and core (abdominal muscles).

VERY IMPORTANT: Any of these exercise should be performed in a relatively pain-free manner with the correct form AS QUALITY IS MORE IMPORTANT THAN QUANTITY. For example, the “no pain no gain” motto DOES NOT apply to this condition. You can have a strong stretch or a sense of muscular fatigue, but you SHOULD NOT have an increase of symptoms like sharp low back pain or a cause or increase in leg pain.

  1. Finally, participate in formal physical therapy. A physical therapist will be able to assist you in your recovery with a hands-on approach (manual techniques) and symptom management techniques. This program should also include supervised exercises performed in the clinic with the correct form while also giving you a home exercise program to follow.

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Reference:

Choi YS. Pathophysiology of degenerative disc disease. Asian Spine J 2009. June; 3(1): 39-44.

Cook PM and Lutz GE. Internal disc disruption and axial back pain in the athlete. Phys Med Rehabil Clin N Am. 2000 Nov; 11(4): 837 – 65.

Fadi T et al. Lumbar Degenerative Disc Disease: Current and Future Concepts of Diagnosis and Management. Adv Orthop. 2012: 2012: 970752.

Fritzell P et al. Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976). 2004 Feb 15;29(4):421-34; discussion Z3.

Kushchayev SV et al. ABCs of degenerative spine. Insights Imaging. 2018 Apr; 9(2): 253 – 74.

Medbridge: https://www.medbridgeeducation.com/patient-education-library/condition/109-Lumbar-Stenosis

Yong-Hing K and Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am. 1983. Jul; 14(3): 491-504.

Yu Cl et al. Operative management of lumbar degenerative disc disease. Asian Spine J. 2016. Aug; 10(4): 801-819.

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