Lumbar Degenerative Disc Disease

Lumbar degenerative disc disease (DDD) is defined simply as the wear and tear of the intervertebral disc, which may result from normal aging or be due to longstanding trauma.

Degenerative disc disease in the lumbar spine, or lower back, refers to a syndrome in which age-related wear and tear on a spinal disc causes low back pain.

Intervertebral discs are tough, fibrous structures that act as ligaments between vertebrae, absorbing pressure and providing cushioning for the spinal column. Discs are flexible yet sturdy enough to facilitate movement such as bending forward, backward, and side to side.

Despite what the name suggests, degenerative disc disease is neither considered a true disease nor does it progressively worsen with time. Discs naturally stiffen with use and age, and everyone experiences some disc degeneration. Degenerative disc disease refers only to the condition of painful disc degeneration, and it is not uncommon for symptoms to alleviate as the spine gradually stabilizes.

Makeup of Intervertebral Discs

An intervertebral disc consists of three main parts:

  1. Annulus fibrosis. The disc’s exterior is made up of concentric rings of collagen that twist and bend as the spine moves.

  2. Nucleus pulposus. The disc’s interior is a gel-like mixture of water and proteins that provides cushioning between vertebral bodies.
  3. Cartilaginous endplates. Between the disc and each vertebral body is an endplate made of cartilage that connects the disc to the vertebrae and acts as a gatekeeper, controlling the flow of oxygen and nutrients into the disc space.

Nerve roots and blood vessels only penetrate the outermost area of spinal discs, meaning discs have little restorative ability and innervation. Discs receive nutrition mostly from the diffusion of blood cells through the endplates.

A degenerated disc is marked by a significant decrease in hydration, making the disc inflexible, smaller, and more prone to tearing in the exterior. When one disc degenerates, it can alter the structure and mechanics of the lumbar spine, particularly at the segment surrounding the disc.

Symptoms of Lumbar Degenerative Disc Disease

Most cases of lumbar degenerative disc disease consist of a low-grade, continuous but tolerable back pain that will occasionally intensify for a few days or more.

Symptoms can vary, but general characteristics usually include:

  • Moderate, continuous low back pain. Painful aches at the site of a damaged disc is the most common symptom of a degenerative disc. Pain may spread to the buttocks, groin, and upper thighs. This pain typically feels achy, dull, and can range from mild to severe.
  • Occasional pain flare-ups. Back pain may intensify for several days or weeks then return to a more moderate level. Flare-ups happen as the disc continues to degenerate and the spine gradually stabilizes. Pain flare-ups can be severe and sudden, and can temporarily reduce mobility.
  • Local tenderness. The area of the low back surrounding the degenerated disc may be sensitive to touch. Local soreness is caused by inflammation and muscle tension surrounding the degenerated disc.
  • Leg pain. Neurological symptoms including numbness, weakness, or sharp, shooting pains in the buttocks, hips, and/or back of the leg may be felt if the disc space collapses enough to pinch a nerve root exiting the spine. Leg pain from lumbar degenerative disc disease usually does not go below the knee.
  • Giving out symptoms. A feeling of sudden weakness or instability can happen as the disc becomes weaker, creating a sensation that the low back will “give out” with sudden movements.

Additionally, pain will typically feel better or worse with certain movements, positions, and postures, such as:

  • Pain with sitting. Sitting for prolonged periods often causes more severe low back pain and stiffness until standing up or changing positions. Sitting in a reclined, supported position is usually well tolerated.
  • Exacerbated pain with bending or twisting. Twisting the spine and forward, backward, and side-to-side bending can cause intense, concentrated pain around the disc.
  • Pain relief when walking or changing positions. When the spine changes positions, pressure is removed from the discs and placed on muscles and joints. Frequently changing positions, alternating between standing and sitting, or taking short walks can help alleviate stiffness and keep pain to a minimum.

Disc degeneration should not cause symptoms of bowel/bladder dysfunction, fever with back pain, unexplained and rapid weight loss, or intense stomach pain. These symptoms are suggestive of more serious conditions and should receive prompt medical attention.

surgical treatment options

Surgical treatment is an option in cases of severe, debilitating lumbar degenerative disc disease, and is usually only recommended after at least 6 months of nonsurgical treatment. Most cases of degenerative disc disease can be managed using nonsurgical methods, and do not require surgery for effective pain relief.

Spinal surgery is always elective, meaning that it is the patient's decision whether or not to undergo surgery.

It is recommended to take all factors into consideration before proceeding with a decision to have surgery for degenerative disc disease, including the length of the recovery period, pain management during recovery, rehabilitating the spine as it heals, and how recovery will affect daily life.

Lumbar Spinal Fusion Surgery

The standard surgical treatment for lumbar degenerative disc disease is a fusion surgery, in which two vertebrae are grafted together. The goal of fusion surgery is to reduce pain by eliminating motion at the spinal segment.

Fusion procedures can differ in how the spine is approached and the methods or tools used to fuse the joint. All spinal fusion surgeries consist of the following:

  • The affected spinal disc is entirely removed from the disc space (a discectomy).
  • The set-up for fusion is put in place, which may consist of a bone graft and/or instruments that further stabilize the spine, such as implants, plates, rods, and/or screws attached to the two vertebrae being fused.
  • The vertebrae then grow together, changing the joints to a solid, immobile structure. Fusion happens in the months following the procedure, not during the surgery itself.

Physical therapy, pain medication, and/or a back brace may be prescribed following surgery to manage pain and help strengthen the low back as the spine heals. Recovery from spinal fusion can take up to a year as the vertebrae grow together and the spine heals.

Artificial Disc Replacement Surgery

Artificial disc replacement has been developed in recent years as an alternative to spinal fusion. An artificial disc replacement surgery consists of removing the full spinal disc (a discectomy), returning the disc space to a natural height, and implanting an artificial disc device.

These devices are typically made of:

  • Two metal endplates that attach to the vertebral bodies and typically include a porous coating that encourages the bone to graft to the device.
  • A central core made of surgical-grade plastic (polyethylene) or metal alloy that bends or turns to allow for movement at the spinal segment.

This procedure is intended to maintain movement in the spine similar to natural movements, reducing the chance of increased pressured placed on adjacent spinal segments (a somewhat common complication of spinal fusion).

Recovery from artificial disc replacement surgery typically lasts up to 6 months as the body heals from surgery and the spine adjusts to the device.

If you'd like to discuss this condition with one of our doctors, we would be more than happy to contact you.  You don't need a primary care physician referral for us to see you. 

 

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