Degenerative Discs

What is it?

Degenerative disc disease (DDD) is not really a disease. It is a term that describes normal changes in the spine that occur with age. With age, spinal discs lose fluid, becoming less flexible and the body often puts down bone to help support the spine. This can lead to bone spurs around the disc, which are typical age related changes.

The disc degeneration and the bone spurs themselves are rarely painful. If the discs cause narrowing where the spinal nerves travel through or exit the spine (referred to as stenosis), this may lead to nerve symptoms. Stenosis does not always cause symptoms either, particularly if the narrowing occurs very gradually over time.

What causes it?

Disc degeneration occurs in areas of the spine where there is more mechanical load or stress. A disc that was once herniated will often show signs of degeneration over time.

Like with disc herniations, trauma or mechanical forces may lead to disc degeneration. An overly sedentary or inactive lifestyle also increases disc degeneration.

Smoking or nicotine exposure is also a risk factor for disc degeneration.

Again, genetics play perhaps the largest role in how our spines age.

Little is known about nutritional factors, but there are Vitamin D receptors in discs (another reason to take Vitamin D).

How is it diagnosed?

Disc conditions are typically diagnosed by a careful history and physical examination.

X-ray is sometimes helpful to clarify the extent of degeneration, and rule out less common causes of pain. MRI or CT are generally not necessary unless there are nerve symptoms or pain not responding to usual treatments.

What are the treatment options?

• Nonsurgical: Nonsurgical treatment is considered the gold standard for disc pain even if that pain extends into the arms or legs. Our team works to accurately diagnose a herniated disc by performing a thorough history and physical examination, including a complete assessment of your musculoskeletal and neurological symptoms. Treatment is focused on decreasing pain, improving the biomechanics of your spine and limbs through flexibility and strengthening, and helping you learn to manage your symptoms and activity level. This may involve physical therapy, manual medicine, activity modifications, medication management, and occasionally injections.
• Physical therapy: There are many different types of physical therapy. Our team will decide which approach is best for you. In general an active approach in which you are given exercises and stretches is recommended. Aerobic exercise is also important, not only for your back condition, but also for your general health and well-being. There is no way to predict how many PT sessions you will need. However, you should feel that there is clear progress within a few visits and many people only need 6 to 8 visits.
• Manual medicine: At times, there are restrictions to normal movement in joints and/or soft tissues areas that either lead to pain or cause increased strain in another region. There are numerous techniques employed in manual medicine, and the treatment choice is individualized for the patient. Our team will guide your treatment for your specific needs. It is difficult to predict how many sessions are necessary, but there should be clear progress within a few visits.
• Activity modification: For very acute pain, a temporary decrease in activity without too much restriction may be indicated, though it is recommended to remain as active as possible, as bed rest for more than a few days has been shown to make disc conditions worse.
• Medications: Analgesic medications such as acetaminophen or an anti-inflammatory such as ibuprofen can be helpful temporarily. Our team will tailor your medications to help you stay active. This may include prescription anti-inflammatories, medications that target nerve pain, and muscle relaxers. For very acute and severe pain, narcotics may be used for a short period.
• Stem cell therapy: An investigational nonsurgical alternative for disc conditions. Insurance does not currently pay for this treatment, as large-scale scientific studies have not proven if it works.
• Surgical: For disc pain that does not go into the arms or legs, surgery is not usually indicated, and in some cases has the potential to make things worse. If you have disc pain that is not responding to other treatments, our team will carefully evaluate your individual case to ensure the most up-to-date treatments have been considered.