What is degenerative disc disease?
Degenerative disc disease is the herniation of the intervertebral disc, more often called as ruptured disc, which results to the protrusion of the nucleus of the disc into the annulus or the fibrous ring around the disc, which subsequently causes nerve compression. Due to the degeneration of the disc, the capsule may push against the spinal canal or it can rupture ensuing the pushing back of the nucleus pulposus in opposition to a spinal nerve, thereby producing pain. If this pressure is not relieved, it will result to degenerative changes such as changes in sensation and deep tendon reflex among others. The two common degenerative disc diseases involve the neck or the cervical area of the spine and the sciatica.
- Degenerative disc disease in the neck or the cervical area of the spine occurs when the degeneration of the disc due to the natural works of aging and spondolysis or the stiffening of the cervical vertebra result to stress in the cervical area of the spine. It usually occurs in the C5-C6 and C6-C7 interspaces. The stiffness and pain may be felt over the neck and a part of the shoulders and even scapula. Moreover, tingling sensation may be felt in the upper extremities. Medical management include pharmacologic therapy such as non-steroidal anti-inflammatory drugs (NSAIDs) to relieve acute pain and muscle relaxants to provide comfort by fighting off muscle spasm; and surgical interventions such as excision of the herniated disc if symptoms fail to improve through cervical discectomy to ease out the debilitating symptoms of the disease.
- The sciatica degenerative disc disease, on the other hand, occurs when lumbar disc herniation happens. It usually occurs at the L4-L5 and L5-S1 interspaces. The most common presenting symptom of the disease is low back pain with accompanying motor and sensory impairments, radiating from the hip down to the leg or the sciatica. Muscle spasms also accompany this pain sensation. People affected should avoid activities that increase cerebrospinal fluid pressure such as bending, lifting and straining (coughing) as it aggravates the pain sensation felt. Moreover, postural deformity may take place since alteration in normal spinal mechanics can occur attributing to the pain sensation felt. Other common signs and symptoms are changes in the tendon reflex, muscle weakness and loss of sensory functions. Just like the cervical degenerative disc disease, medical management include pharmacologic therapies that relieve pain and counter inflammation such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids as well as muscle relaxants to provide comfort by fighting off muscle spasm; and surgical interventions such as lumbar disc excision through posterolateral laminotomy, microdiscectomy and percutaneous discectomy among others.
Degenerative disc disease causes
The delicate spinal cord is composed of vertebral bodies that are cushioned by cartilagenous plates called intervertebral disc. This tough, fibrous material is encapsulated and has a nucleus called the nucleus pulposus. The herniation commonly occurs when this nucleus pulposus protrudes into the annulus or the fibrous ring around the disc. This will then result to nerve compression. Along with the degeneration of the disc comes the pushing of the capsule against the spinal canal, thereby pushing back the nucleus pulposus against the dural sac or against a spinal nerve. Pain will now then result and other manifestations such as sensory changes. This sequence of events is usually caused by aging and trauma to the spinal cord due to vehicular accidents among others.
Degenerative disc disease symptoms
The clinical manifestations or the symptoms of the degenerative disc disease vary depending on the location of the trauma (cervical, thoracic or lumbar), the development rate (acute or chronic) and the extent of the damage to neighboring structures. However, the common clinical manifestations or symptoms of the disease are pain in the affected area, stiffness, paresthesia or tingling sensation, numbness, muscle weakness, sensory loss and alterations in the tendon reflexes.
Degenerative disc disease Pictures
Picture 1 : Degenerative Disc Disease location
Image source : degenerativediscdisease.org
Picture 2 : Degenerative disc disease and other spine conditions
Image source : backpainpro.info
Picture 3 : Top view of lumbar vertebrae showing normal and degenerative disc
Image source: empowher.com
Picture 4 : Compressed and healthy disc difference
Image source : doctorpinchback.com
Degenerative disc disease diagnosis
The first step in the diagnosis of the degenerative disc disease is conducting a thorough physical assessment or examination to rule out any potential serious complications such as cauda equina syndrome among others. After conducting the physical examination, a magnetic resonance imaging or MRI scan (diagnostic tool of choice) is being done to localize or find out the areas of disc protrusions even the small ones. In addition, computed tomography or CT scan and myelography or the x-ray examination of the spinal canal is being run if the clinical symptoms do not coincide with the pathology seen on MRI. Afterwhich, a thorough neurologic examination is conducted in order to determine what particular sensory, motor and reflex impairments are present. It can also serve as baseline data for future assessments. Furthermore, electromyography is done in order to localize the specific nerve roots affected.
Degenerative disc disease treatment
The goals of treatment of degenerative disc diseases are to rest and immobilize the area affected. This is done to give the soft tissues sufficient time to heal, as well as to decrease the inflammation in the supporting tissues and the affected nerve roots. Pharmacologic therapies include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids to relieve acute pain and counter inflammation. Muscle relaxants are also administered to fight off musscle spasms, thereby providing comfort.
However, if the condition is not responsive to conservative management (rest and medications) and neurologic deficit is progressing, surgical excision of the herniated disc may be necessary. Because if this is not done, loss of sensory and motor functions as well as muscle weakness and atrophy may occur. There are a few of surgical techniques employed in surgical excision depending on the type of disc herniation and surgical morbidity. These surgical techniques are as follows: discectomy, laminectomy, hemilaminectomy, partial laminectomy or laminotomy, discectomy with fusion and foraminotomy.
Degenerative disc disease exercises
The exercises used for degenerative disc disease include the dynamic lumbar stabilization program. This program is progressive in nature, meaning, easy executions are done first and progressively elevates to ones that are more difficult. The following is a rundown of these exercises for degenerative disc disease:
Hook-lying march – This exercise is executed by lying on your back, and then having your both knees bent and both arms on either side. To start off, tighten your stomach muscles, and slowly raise your legs alternately three to four inches above the floor. You can do this in three repititions with a 30-second break every after repititions.
Hook-lying march combination – This exercise is done same as the hook-lying march, however, with both arms raised and lowered over your head.
Bridging – This exercise is done by lying on your back and then having your both knees bent. Afterwhich, slowly raise your buttocks from the floor for at least eight seconds and then lower down to your starting position. You can initially repeat this ten times and as your strength and endurance builds, you can opt to do two or three repititions of ten buttock lifts.
Now, instead of lying on your back, this particular exercise is conversely done with lying flat on your stomach. Tighten your stomach muscle and then raise one leg behind with your knee slightly bent and make sure there is no arch in your back or neck. Hold this position for at least four seconds and then slowly go back to starting position. You can initially repeat this two times alternating both of your legs.
Another variation of the above exercises is done in a four-point position. Meaning, you kneel on your hands and knees. To start off, raise one leg behind with your knee slightly bent and make sure there is no arch in your back or neck and raise your opposite arm as well. Hold this position for at least four seconds. You can initially repeat this two times alternating the opposite sides of your arms and legs.