DEGENERATIVE DISC DISEASE – An Overview
Our spine goes through a lot of wear and tear as it supports movements. The spinal vertebrae are cushioned by discs which safeguard against shocks and jerks from activities like walking, lifting and twisting. Degenerative disc disease is associated with changes in these intervertebral discs that arise with age. The abnormalities can occur anywhere in the spine but most often it is observed in the neck region (cervical spine) and the lower back (lumbar spine) because these bones support the maximum movement. The changes in the discs that can be termed as degenerative disc disease are:
- Osteoarthritis, the impairment of the tissue that protects and cushions vertebral joints
- Herniated disc, protruding or cracking of spinal disc
- Spinal stenosis, abnormal contraction of the spinal canal,
Causes Degenerative disc disease
The discs hold a soft gel-like substance that prevents friction. With age, the spinal discs degenerate and undergo changes like:
- Loss or drying of disc fluid: This affects the shock absorption capacity of the discs and its flexibility. The disc narrows down and the gap between disc and vertebrae increases.
- Bulging disc or herniation: Weakness or external injury results in a minor crack on the outer layer of the disc. The gel substance leaks out and with movement, it is forced out of the gaps. This can cause the disc to bulge, rupture or break.
- Bone spur: If the disc narrows or cracks, the gap between disc and vertebrae increases and spine become less stable. The body responds to this by initiating bony growths called as bone spurs also known as osteophytes. These spurs can exert pressure on the spinal cord or nerve roots that shoot from the cord.
- People with jobs or hobbies that involve heavy weight lifting, can face this issue. Smokers, elderly people or people with a past injury can also suffer from degenerative disc disease.
Symptoms of degenerative disc disease
Back or neck pain is the most common symptom in any of the degenerative disc diseases. However, there have been cases where the person does not experience any pain even with the same intensity of damage.
The pain occurs around the affected area. If the disc is damaged near the neck, the pain is experienced along the shoulder blade and the arms. If the lumbar spine is affected the pain spreads to the buttock, thighs till the knees. This pain gets worse with movement like twisting, bending and stretching.
Another common symptom is numbness and weakness in limbs. The tingling sensation can also be felt because a spinal nerve is pinched either by the bone spur or bulging disc.
Elderly patients experience loss of bladder control, difficulty in keeping balance, handling smaller objects etc. This happens due to the narrowing of spinal canal and compression of nerves and spinal cord. The nerve function weakens.
How is degenerative disc disease diagnosed?
It begins with understanding the medical history and a thorough physical exam. The doctor will seek information on the symptoms, duration, past injuries, illnesses or lifestyle, habits, nature of everyday activities etc.
The second step would be to check the range of motion, muscle strength, ease of movement, nerve reflexes, tenderness, and inflammation is any. The doctor might also check for fractures or infections. Post this the patient is suggested Imaging tests which will identify the level of compression and exact location of damage.
Treatment for degenerative disc disease
- Medication and hot/cold packs help ease the pain. If the pain is unbearable, the doctor will prescribe stronger pain reliefs and application ointments.
- Next step is physical therapy, where the therapist will move every joint in a specific sequence. It involves stretching and strengthening the muscles in the back.
- Surgery is the last resort. It depends on the type of degeneration and is necessary if the spinal cord or nerves are compressed either by the narrowing canal or the bulging disc or maybe the bony spurs.
Traditional decompression surgeries performed from the back (posterior) of the spine are:
Facetectomy: Spinal joints called as facet joints are removed if they exert pressure on the nerve or cord.
Foraminotomy: Enlargement of the opening is made for the nerve to exit without pressure in case a part of the disc or bone spur blocks its path.
Laminectomy: Lamina is the posterior portion of the vertebrae that protect the spinal canal and cord. If it is pressing the spinal cord, surgery is done to remove part or whole of the lamina to ease the pressure on the cord.
Laminotomy: Similar to the foraminotomy, a bigger opening is made in the lamina if it is pressing a nerve structure. The nerves are given more space to exit the cord and reach the limbs.
Traditional decompression surgeries performed from the front (anterior) of the spine are:
These are preferred in case of herniated disc or narrowing of spinal canal and if the spinal cord comes in way of the surgery path.
Discectomy: Parts or all of the herniated disc is removed that exert pressure on nerves.
Corpectomy (Vertebrectomy): If the damaged disc is logged between the vertebrae and the spinal cord, the surgeon might have to remove the entire vertebral body and gain access to remove the part of the disc.
- Minimal invasive surgery or less invasive surgery has come in as a relief for patients that suffer from degenerative disc surgery. Discectomy is done with this technique where microscope and advanced surgical tools are used for the process. A very small incision is used to insert the tools and procedure indirectly monitored.
These surgeries leave a gap between the organs, which is filled using FUSION. An environment is created using bone graft which will gradually fuse with the spine.
Recovery and post-surgery follow-up
If the surgery involves a fusion, it takes some months for the area to heal completely and the bones to fuse together. Local pain might persist. In minimally invasive surgery the incision heals faster and since the muscles are not involved, the pain is lesser. There can be few follow-up sessions where the doctor will monitor the progress and check the range and ease of movement.
Cost of surgery
Degenerative disc disease is a condition and there are different types of surgeries that can cure it depending on the exact abnormality. Complicated surgeries that involve fusion or removal of the vertebral body can cost more than minor surgery. It vary from patient to patient.