Find comprehensive information on degenerative disc disease, including symptoms, causes, and physical therapy options.

Degenerative Disc Disease

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Degenerative disc disease (DDD) is characterized by the progressive wearing down of the spinal discs. 
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Spinal discs are rubbery cushions located between the vertebrae. They act as shock absorbers, allowing one to move, bend, and twist more comfortably. These discs degenerate over time, a natural part of the aging process. However, not everyone will develop degenerative disc disease.

Degenerative disc disease is not a disease, but a condition characterized by age-related wear and tear of the disc. This leads to pain, instability, and other symptoms. 
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Degeneration of the intervertebral discs is a common cause of back pain. While the degeneration can occur at any level of the spine, it most commonly affects the cervical and lumbar spine.&nbsp;

An estimated 30% of people aged 30-50 years have some degree of disc degeneration<a href="#accordion">[4]</a>.&nbsp;&nbsp; 
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There are no specific subtypes of degenerative disc disease. 
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Signs and Symptoms

The cervical and lumbar spine are most susceptible to wear and tear. Therefore, degenerative disc disease typically presents with neck and back pain. The pain may range from mild to severe and debilitating. Furthermore, it may: 
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<ul>
	<li>Radiate to the thighs and buttocks</li>
	<li>Lead to tingling or numbness in the arms or legs</li>
	<li>Worsen with sitting, twisting, or bending, and get better with walking</li>
	<li>Last for weeks or months</li>
	<li>Come and go, changing in severity 
	&nbsp;</li>
</ul>

In rare circumstances, degenerative disc disease can cause the leg muscles to weaken. This indicates that the damaged discs may be impacting the nerves in the spine. 
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Causes

The inner core of the spinal discs is soft, while the exterior wall is tough. The discs undergo changes that may lead to degenerative disc disease, such as: 
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<h5>Dry Out</h5>

The discs in the spine are primarily formed of water at birth. They lose water and become thinner with age. Flatter discs less efficiently absorb shocks. The lack of water also means less cushion or padding between the vertebrae. This might create various issues in the spine, including discomfort. 
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<h5>Crack</h5>

Over time, the stress of everyday movements and minor injuries can cause tiny holes in the outer wall, which contains nerves. Any rips close to the nerves might be painful. If the wall breaks, the disc&#39;s soft center may push through the fractures. A herniated or slipped disc develops when the disc bulges or slips out of position. It has the potential to harm adjacent nerves. 
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There are no specific screening tests or guidelines for degenerative disc disease. Since the condition occurs as a normal part of aging and is often asymptomatic, doctors may discover it incidentally while evaluating the patient for other spinal disorders. 
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Diagnosis

To diagnose degenerative disc disease, the physician will first inquire about the patient&rsquo;s symptoms and medical history. They may ask: 
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<ul>
	<li>When did the pain begin?</li>
	<li>Which section of the spine hurts?</li>
	<li>If it has extended to other regions of the body </li>
	<li>If the person has experienced previous spine injuries</li>
	<li>If there is a family history of such issues. 
	&nbsp;</li>
</ul>

Next, they&#39;ll examine the spine for symptoms of the illness, such as pain in the lower back or neck. They may also request that the person walks or bends to determine which actions cause discomfort. Furthermore, the patient&rsquo;s muscle strength is evaluated, as well as their nerve function. 
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The physician may also conduct an X-ray, MRI, or CT scan to check for bone or nerve damage near the spine. 
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Treatment

Treatment options for degenerative disc disease may include one or more of the following: 
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<h5>Heat Or Cold Therapy</h5>

Cold packs can assist in relieving pain related to a damaged disc, whereas heat packs may minimize the inflammation that causes pain. 
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<h5>Over-The-Counter Medications</h5>

Acetaminophen and NSAIDS, such as ibuprofen can help relieve pain while also reducing inflammation. However, they can cause side effects when combined with other medications. It is best to consult a doctor before using any medication. 
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<h5>Prescription Pain Relievers</h5>

When over-the-counter pain relievers fail, doctors may prescribe prescription painkillers. These options should be used as a caution because they carry the risk of dependency and should only be used in severe pain cases. Doctors may also prescribe steroids and muscle relaxants. 
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<h5>Steroids</h5>

Steroids may be injected near the spinal discs, nerves, or joints to help reduce pain and inflammation. 
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<h5>Physical Therapy</h5>

A physical therapist will lead the patient through exercises that will assist in strengthening their back muscles while relieving discomfort. Over time, the patient will see improvements in discomfort, posture, and general mobility. 
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<h5>Surgery</h5>

The healthcare provider might suggest either an artificial disc replacement or a spinal fusion depending on the severity of the issue. Surgery may be required if the discomfort worsens or persists despite multiple nonsurgical treatments. Some surgical options for degenerative disc disease are: 
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<ul>
	<li>Artificial Disc Replacement -. The damaged disc is replaced with a new one made of plastic and metal in artificial disc replacement.</li>
	<li>Spinal Fusion - Damaged vertebrae are fused together to strengthen them.</li>
	<li>Discectomy - Part of the spinal disc is removed to relieve pressure on the nerves.</li>
	<li>Laminectomy - A small portion of the bone (lamina) from the lower spine is removed.</li>
	<li>Other spinal decompression surgeries, such as foraminotomy and osteophyte removal may also be used. 
	&nbsp;</li>
</ul>

<h5>Intradiscal Electrothermal Annuloplasty (IDET) </h5>

A catheter is inserted into the disc and heated. This causes collagen to contract, repairing damage in the disc and reducing pain. 
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<h5>Facet Rhizotomy</h5>

A radiofrequency current is applied to the facet joint to kill the nerves and prevent pain signals from reaching the brain. Thus, providing pain relief. 
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<h5>Exercise For DDD</h5>

Exercise can support other DDD treatments by enhancing the strength of the muscles that surround the injured discs. It can also alleviate painful swelling by improving blood flow and providing nutrients and oxygen to the afflicted region.

The first type of exercise that can assist with DDD is stretching. This helps to wake up the back. Stretching is also essential before beginning any form of activity.

Yoga is beneficial in the treatment of back pain, and regular practice leads to enhanced flexibility and strength. These stretches may be done at one&rsquo;s desk to reduce back and neck pain caused by their job. 
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In an advanced form of degenerative disc disease, people can develop back osteoarthritis due to the discs rubbing against one another. This can cause back pain and stiffness, severely limiting mobility. 
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Exercise is vital for overall health, especially if one has DDD-related back pain. Immobility or reduced mobility may increase the likelihood of: 
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<ul>
	<li>Worsening pain</li>
	<li>Decreased muscle tone</li>
	<li>Reduced flexibility in the back</li>
	<li>Blood clots in the legs</li>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a> 
	&nbsp;</li>
</ul>

Age is one of the most vital risk factors for DDD. As one ages, the discs between the vertebrae naturally shrink and lose their cushiony support. Almost every adult over the age of 60 suffers from some form of disc degeneration. However, not all cases are painful.

People with a significant back injury might be at a higher risk of acquiring DDD. Prolonged repetitive activities that put pressure on specific discs can also increase the risk. 
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Other risk factors are as follows:

<ul>
	<li>Car accidents</li>
	<li>Overweight or obesity</li>
	<li>A sedentary lifestyle 
	&nbsp;</li>
</ul>

&ldquo;Weekend warrior&quot; exercise can also put people at risk. Instead, one should aim for moderate daily exercise to strengthen their back while minimizing stress on the spine and discs. 
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Lifestyle changes can help to prevent or slow the progression of spinal degeneration. Some examples are: 
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<ul>
	<li>Obtaining and maintaining a healthy body weight.</li>
	<li>Smoking cessation.</li>
	<li>Exercising regularly to improve strength and flexibility. 
	&nbsp;</li>
</ul>
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Low back pain is a common problem that can make it difficult for people to move and work. It happens when the discs between the bones in the spine wear down over time. Doctors use a special kind of picture called an MRI to see what&#39;s happening inside the spine, but sometimes the images aren&#39;t detailed enough to catch early signs of the problem. 
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Magnetic resonance imaging (MRI) is a helpful tool in diagnosing degenerative disc disease (DDD) as it can accurately show spinal and intervertebral disc (IVD) morphology. However, current MRI technology cannot detect subtle changes in IVD tissue composition and cell metabolism. A recent review discusses new MRI techniques that can detect and measure matrix composition, integrity, and biomechanics changes in the early stages of DDD<a href="#accordion">[1]</a>. Implementing this new technology in clinics can help diagnose DDD early and guide conservative and regenerative treatments to prevent the disease from getting worse. 
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Regular MRI is commonly used to check intervertebral discs, but new techniques called QMRI can measure tissue changes on a molecular level. These techniques can identify early signs of disc degeneration and assess the effectiveness of regenerative treatments. However, QMRI technology still needs to improve before it can be used in hospitals to detect degeneration and evaluate treatment results. 
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Key Points

<ul>
	<li>Degenerative disc disease (DDD) is a disorder where the intervertebral discs, which act as cushions between the vertebrae, begin to break down and degenerate.</li>
	<li>Symptoms of DDD may include back pain, stiffness, and decreased mobility.</li>
	<li>DDD can be caused by aging, injury, genetics, or other factors.</li>
	<li>Treatment options for DDD, including physical therapy, medication, and surgery of DDD.</li>
	<li>Prevention measures may involve maintaining a healthy weight, regular exercise, good posture, and avoiding smoking.</li>
	<li>DDD is not necessarily progressive, and not everyone will experience symptoms.</li>
	<li>DDD can be diagnosed through medical history, physical exams, and imaging tests like X-rays, MRI, or CT scans. 
	&nbsp;</li>
</ul>
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[1] Carlo A. Mallio 1ORCID, Gianluca Vadalà 2ORCID,Fabrizio Russo 2,*ORCID,Caterina Bernetti 1,Luca Ambrosio 2. "Novel Magnetic Resonance Imaging Tools for the Diagnosis of Degenerative Disc Disease: A Narrative Review." MDPI, 2022:

[2] Filippiadis, Dimitrios K. "A review of percutaneous techniques for low back pain and neuralgia: current trends in epidural infiltrations, intervertebral disk and facet joint therapies." BIR, 2015:

[3] Nouri, Aria MD, Lindsay BSc Tetreault, Anoushka PhD Singh, Spyridon K. MD, PhD Karadimas, and Michael G. MD, PhD, FRCSC, FACS Fehlings. "Degenerative Cervical Myelopathy." SPINE JOURNAL, 2015: