Explaining Spinal Disorders: Lumbar Degenerative Disc Disease

Lumbar (low back) degenerative disc disease (DDD) is a common condition in aging adults. The intervertebral discs serve as the spine’s shock absorbers and, as we age, discs gradually dry out, losing strength and resiliency. In most people, these changes are gradual. In fact, many of our patients don’t know they have degenerative disc disease. They may only become aware of the condition when being examined for another health problem, or during a routine checkup.

Symptoms

Disc degeneration is a normal part of aging, and usually is not a problem. However, DDD can cause discs to lose height and become stiff. When disc height is lost, nerve impingement, bone and joint inflammation, and resultant pain can occur. Disc degeneration causes loss of the joint space, similar to arthritis pain and inflammation. In severe cases, pain may be constant.

Diagnosis

Our practice combines our expertise and advanced diagnostic technology to ensure a correct diagnosis. The diagnostic process includes:

• Medical history. The doctor asks you questions about your symptoms, their severity, and treatments you have already tried.
  
  
• Physical examination. You are carefully examined for limitations of movement, problems with balance, and pain. During the exam, the doctor looks for loss of reflexes, muscle weakness, loss of sensation or other signs of neurological injury.
  
  
• Diagnostic tests. Most doctors start with x-rays, which helps to rule out other problems such a tumor or infection. The films also reveal loss of disc space between the vertebrae. In some cases, a test called Discography confirms the diagnosis. Discography involves injecting contrast dye into the affected disc (or discs) to create a clearer image and temporarily replicate symptoms.

Lumbar spine MRI showing degenerated disc

Above: Sagittal (side view) lumbar MRI shows lumbar disc degeneration of the bottom 3 discs. Note the darkened color and loss of disc height suggesting disc desiccation (drying out). The taller, grey colored discs are more normal.

Nonoperative Treatment

The good news is that most cases of lumbar degenerative disc disease do not require surgery. Many different nonsurgical treatments help relieve symptoms. These include:

• Medications, such as an anti-inflammatory to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally narcotic painkillers to alleviate acute pain.
  
  
• Cold/heat therapy, especially during the first 24-48 hours.
  
  
• Spinal injections (i.e. epidural) may help relieve low back and leg pain.
  
  
• Physical therapy, which may include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
  
  
• Chiropractic or alternative therapy (i.e. acupuncture).

In conjunction with these treatments, our staff will educate you about healthy posture and proper body mechanics.

Surgical Treatment

If symptoms of lumbar DDD persist, despite nonoperative treatments, further diagnostic tests may be necessary. Tests may include a CT scan, MRI, Myelogram, and possibly Discography. If your surgeon discovers that one or more intervertebral discs are damaged, and causing pain or other symptoms (e.g. weakness in muscles), surgery may be necessary. The surgical procedure likely will include a discectomy (removal of the damaged disc) and interbody fusion (fusing together the vertebrae above and below the disc space).

Many procedures are performed using minimally invasive techniques, which can help speed your recovery. Of course, if surgery is necessary, your surgeon will clearly explain the recommended procedure and the benefits and risk.

Conclusion

While lumbar degenerative disc disease is a natural part of aging, it does not mean you have to live with low back pain. We can help you return to a healthy, pain-free and active life. For most patients this is accomplished with nonsurgical treatments. But, even if surgery is needed, be assured we will discuss all procedure risks and benefits and provide you with the best possible care.

In addition treatments, our medical professionals have a deep commitment to patient education. By helping you understand the cause of your condition, we can help you eliminate risk factors and instill spine healthy habits for a lifetime. While you are under our care, our medical staff will provide you with excellent information to help you recover, minimize risk factors, and stay healthy.