Degenerative Disc Disease

Definition

Degenerative Disc Disease (DDD) is the deterioration over time of the disc between vertebrae.  As aging occurs, the body's cartilage becomes thinner and more fragile. This may cause wear and tear to the discs and joints in the vertebrae, also called facet joints. Another name for this condition is spondylosis. It can be seen in medical imaging such as X-rays or MRI scans as a narrowing of the space between vertebrae, confirming the diagnosis.

Causes 

Excessive pressure or disc injuries can harm the annulus, or outer ring of tough ligament material connecting vertebrae, often the first part of the disc to be injured. This usually begins as small tears that heal as scar tissue, which is weaker than normal ligament tissue. As more scar tissue forms the annulus is weakened further, eventually harming the nucleus pulposus in the discs, which then begin to dry. Drier discs are less able to function as cushions between vertebrae. Bone spurs may also form around the disc space and facet joints, becoming a problem if they start to grow into the spinal canal and press into the spinal cord and spinal nerves -- a condition known as Spinal Stenosis

Symptoms

Pain in the back, spreading to the buttocks and upper thighs.

Diagnosis of Degenerative Disc Disease

X-rays: Your doctor may require X-rays of your mid back to assess the severity of wear and tear in the spine, or identify a calcified disc. If part of a calcified disc points into the spinal cord, it's a good indication of a herniated thoracic disc.

MRI: This painless and very accurate imaging technology is the most common diagnostic tool for this condition. It's  the preferred test after X-rays in order to diagnose a herniated thoracic disc.

CT Scan: If X-ray and MRI aren't sufficiently determinative, a myelogram, usually combined with a CT scan, may be required.

Nonsurgical Treatment

Observation: Simply watching to hopefully ensure that the condition doesn't progress. If pain is bearable and other symptoms aren't deteriorating, watching and waiting may be the best course, as determined by your physician.

Rest and Activity Modification: For more severe pain a decrease in activity or outright rest may be in order, as well as a back brace to limit movement around the injured disc. When returning to activity after the prescribed number of days, begin with a gentle walking program, increasing distance each day.

Pain medications: These can help control pain. Over-the-counter pain relievers such as ibuprofen, Tylenol®, and newer anti-inflammatory medications, may help.

If these fail to control the pain, your doctor may prescribe narcotic or non-narcotic medications. Narcotic pain medications are very strong, but very addictive. Non-narcotic pain meds are less addictive, but somewhat less effective. Most physicians don't like to prescribe narcotics for longer than a few days, or at most a few weeks.  

Physical Therapy: For mild non-deteriorating symptoms your doctor may prescribe physical therapy. A well-rounded rehabilitation program helps calm pain and inflammation, and improves your mobility and strength.

Surgical Treatment for Degenerative Disc Disease

Laminotomy and Discectomy: Discectomy is the removal of the part of a herniated disc that irritates a nerve, causing pain.  The surgeon first removes part of the lamina of the vertebra, which is the roof over the spinal nerves, in order to reach the spinal canal. The nerves are gently moved aside, allowing herniated disc material to be removed and freeing the nerves from irritation.

Spinal Fusion: Two or more bones are fused into one solid bone -- also known as arthrodesis. When a large section of bone and disc is removed, that part of the spine can become unstable, requiring the fusion of bones above and below that section.

To make the unstable bones grow together, bone graft material is inserted, with plates, rods, and screws holding the bones in place.  

Recovery

Nonsurgical Rehabilitation

Your doctor may prescribe physical therapy several times a week for between four and six weeks -- longer for some patients -- all with the primary goal of controlling symptoms.

Your therapist will help you to find positions and movements that ease pain. In order to help calm muscle spasms and also to ease your pain, the therapist may employ heat and/or cold, the use of ultrasound, and even electrical stimulation. Hands-on treatments such as massage and soft-tissue mobilization may also help you move with less pain and greater freedom. Spinal manipulation -- usually known as an adjustment -- may reset the sensitivity of the spinal nerves and muscles, providing short-term relief for degenerative disc symptoms. Note that this treatment is not an effective long-term solution.

Traction may also be used to stretch the low back joints and muscles. And stretches may be demonstrated for you which will help you move more easily and with less pain.

As you recover, you will gradually advance in a series of strengthening exercises for the abdominal and low back muscles. Working these core muscles helps patients move more easily and lessens the chances of future pain and problems.

A primary purpose of therapy is to help you learn how to take care of your symptoms and prevent future problems. You'll be given a home program of exercises to continue improving flexibility, posture, endurance, and low back and abdominal strength. The therapist will also discuss strategies you can use if your symptoms flare up.

Surgical Rehabilitation

Some patients are discharged shortly after surgery. Some surgeries, however, require patients to remain hospitalized for a few days, and may see a physical therapist soon after surgery. Treatment sessions help patients learn movement and the performance of routine activities without adding strain on their backs.

Patients should follow their surgeon's instructions about wearing a back brace or support belt after surgery, being cautious about overdoing activities during first several weeks.

Many surgical patients require physical therapy once outside of the hospital. Lumbar fusion surgery patients normally should wait for as long as three months prior to starting rehabilitation, typically need eight to 12 weeks of therapy, and may expect full recovery in the range of six months.

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