By William Coon ATC, PTA, CSCS
Degenerative disc disease (spondylosis) is a general term used to describe changes that can occur along any area of the spine (cervical, thoracic, lumbar) as you grow older, but is most common in the lumbar area. Many medical professionals do not classify DDD as a pathology, but rather a normal part of aging. It's not actually a disease, but rather a condition in which your discs "degenerate," or lose their flexibility and ability to cushion your spine. Your discs do not have a good blood supply, so once injured, repair is very difficult.
The most common symptom of degenerative disc disease is localized back or neck pain. When DDD causes compression of the nerve roots, the pain often radiates down the arm or leg. Tingling and/or numbness may also be felt. In more severe cases of cervical or lumbar DDD, where there is evidence of nerve root compression, individuals may experience motor weakness. Although centralized pain is concerning, neurological compromise and symptoms that radiate away from the spine far outweigh localized back or neck pain and should be addressed immediately.
Primary management for DDD is non-operative and includes nonsteroidal anti-inflammatory medications (NSAIDs) and physical therapy.
Physical therapy may include exercise programs to strengthen abdominal and spinal musculature, improve aerobic fitness, and preserve the normal inherent curvatures of the spine. The goal of physical therapy is to help you return to full activity as soon as possible. Exercise is very helpful for the pain associated with degenerative disc disease, and it may help decrease symptoms. Physical therapists can instruct you on proper lifting and walking techniques, and they will work with you to strengthen and stretch your lower back, leg, and stomach muscles. They’ll also encourage you to increase the flexibility of your spine. Activity modification, rest, pain medication, muscle relaxants, and application of ice may be helpful in the acute stages. Proper posturing throughout all daily activity can help prevent further degenerative changes as well as control symptoms. Although your physical therapist may show you strengthening/stretching exercises, it’s your responsibility to follow them.
Injection may be of benefit if progress has reached a plateau with conservative management. Typically cortisone will be used. Cortisone is a strong anti-inflammatory steroid medication. It is commonly injected along with a local anesthetic in order to reduce inflammation in the affected areas. Cortisone is long lasting and can be slow-releasing in order to give the best possible benefits of pain relief. Cortisone may not begin working for several days following the injection, but the effects can last for months. Sometimes a narcotic medication such as morphine or fentanyl is mixed with cortisone and the anesthetic to get increased pain relief. An epidural or facet injection may be used.
An epidural steroid injection is a common type of injection that is given to provide relief from certain types of low back and neck pain. The "epidural space" is the space between the covering of the spinal cord (dura mater) and the inside of the bony spinal canal. It runs the entire length of your spine. When injected into this area the medication moves freely up and down the spine to coat the nerve roots and the outside lining of the facet joints near the area of injection. For example, if the injection is given in the lumbar spine, the medication will usually affect the entire lower portion of the spine.
Facet joint injections are used to localize and treat low back pain caused by problems of the facet joints. These joints are located on each side of the vertebrae. They join the vertebrae together and allow the spine to move with flexibility. The facet joint injections form a pain block that allows the doctor to confirm that a facet joint is causing the pain. The medication used also decreases inflammation that occurs in the joint from arthritis and joint degeneration.
Surgical intervention is an option when nonoperative medical management fails to adequately relieve the intolerable pain during activities of daily living which is individual-specific. Surgery is rarely recommended unless you have a proven disc herniation or instability and your symptoms do not significantly improve with nonsurgical treatments. The goal of surgery is to stop the movement of the painful motion segment and decompress any spinal nerves. It is important to remember that while 80% of people will experience back pain during their lifetime, the pain tends to be brief and resolves with little or no medical treatment. You should understand what surgery can and can’t do, and whether it can relieve your particular symptoms. Talk to your doctor about whether surgery is right for you.
© 2008 The Orthopaedic Group, LLC Not to be reproduced without the express permission of the author