DEGENERATIVE DISC DISEASE(DDD) is part of the natural process of Increasing Age. A back injury can hasten these changes. Disc degeneration has a pattern in its progress. First, the nucleus (the center of the disc) begins to lose its ability to absorb water, then it becomes thick and fibrous, losing its shock absorbing ability. Tears appear around the annulus (the outer shell of the disc).
The combination of damage to the intervertebral discs, the development of bone spurs, and a gradual thickening of the ligaments that support the spine contribute to degenerative arthritis of the lumbar spine ( termed widely as Spondylosis ). Over time these changes can also lead to narrowing, or stenosis, of the spinal canal.
Narrowing of the lumbar spinal canal pinches the nerves that control muscle power and sensation in the legs. Occasionally They can lead to the forward slippage of one vertebra on another. This slippage, called "Degenerative Spondylolisthesis," can cause both back and leg pain.
However, not everyone who has degenerative changes in their lumbar spine has pain. Many people who have "normal" backs have MRIs that show disc herniations, degenerative changes, and narrowed spinal canals. Every patient is different, and it is important to realize that not everyone develops symptoms as a result of degenerative disc disease.
COMMON SYMPTOMS Include
Typically patients with DDD/ lumbar spinal stenosis have a long history of pain in the back, buttocks or legs that gradually becomes worse. The symptoms are usually worsened by standing or walking upright. Walking for a certain distance results in an achy pain, tightness, heaviness and a sense of weakness in the buttocks and/or legs (Claudication). These symptoms are generally relieved by sitting down or leaning forward.
Some patients also find that it is easier to walk while leaning forward on a shopping cart. Sometimes the pinched nerves become inflamed and cause pain in the buttocks and/or legs- Sciatica. People complain of back pain and stiffness, especially towards the end of the day.
Warning Signs:
- Pain is getting worse
- Disabling pain
- Leg weakness, Pain, Numbness, or Tingling.
- Loss of bowel or bladder control
Risk Factors/Prevention
Middle-aged and older adults are commonly affected. People who are born with narrower spinal canals are more likely to develop this problem early in life( primary lumbar canal stenosis).
Regular exercise can improve endurance and keep the muscles that support the spine strong. Avoiding weight gain can decrease the load that the lumbar spine has to carry. Patients should also avoid cigarette smoking.
Diagnosis
The diagnosis of degenerative disc disease begins with a complete physical examination of the body, with special attention paid to the back and lower extremities.
X-RAYS
If DDD, the x-rays will often show a narrowing of the spaces between the vertebral bodies. Bone spurs begin to form around the edges of the vertebral bodies and also around the edges of the facet joints, the space available for the nerve roots starts to shrink.
MRI / CT Scan
A MRI scan is very useful for determining where disc herniations have occurred and where the nerve roots are being compressed. A CT scan is often used to evaluate the bony anatomy in the spine, which can show how much space is available the nerve roots and within the neuroforamen and spinal canal.
TREATMENT
GOAL OF TREATMENT - to ease pain and other symptoms so the patient can resume normal activities as soon as possible.
Non-Operative Treatment:
Though 80% of adults will experience back pain, only 1-2% will need lumbar spine surgery. Over prescribed long courses of bed rest and/or lumbar (low back) traction for their patients with low back pain. However its relevance presently is during the acute phase,wherein bed rest may be recommended for a few days, but beyond that experts advocate stretching, flexion and extension exercises, and no/low impact aerobics. Each patient is different and therefore so is their treatment plan.
Drug Therapy
During the acute phase drugs may be prescribed. Some may include anti-inflammatory agents, muscle relaxants, narcotics, and anti-depressants. Narcotics are used on a short-term basis partly due to their addiction potential
Therapeutic Exercises, Acupressure, Manipulation Pain Management Techniques:
- Epidural Steroid Injections (ESI)
- Nerve Root Blocks
- Facet Blocks and Rhizotomy
SURGERY
In general, surgery is only considered as a last resort if all attempts at non-surgical therapies are unsuccessful and if the overall potential benefits of surgery are greater than the potential risks.
Surgery for LCS is mostly for “Quality of life” which is very individual specific.
The main types of surgery for degenerative disc problems include Lumbar Laminectomy with or without discectomy
Discectomy
- Standard Discectomy
- Micro discectomy
- Endoscopic discectomy
Fusion
- Posterior Fusion Techniques
- Poster lateral fusion with Instrumentation
- Post. Interbody Fusion (PLIF)
- TLIF
- Anterior Interbody Fusion
Fusion eliminates motion and prevents the slippage or curvature from worsening after surgery, which would cause more back and/or leg pain. Your surgeon may use screws and rods to hold the spine in place while the body heals the bone together. Using screws and rods increases the rate of fusion and enables the patient to get out of the postoperative brace sooner. Overall the results of surgery are good to excellent. Most patients are able to resume a normal lifestyle after a period of recovery from surgery.
