If you suffer with back pain, you might be interested to know you are not alone. A large percentage of my patients come to me for this very reason, complaining of lower back or neck pain. When I mention the word degenerative disc disease, they seem confused because they immediately think their pain will get progressively worse. It is understandable that patients find the words “degenerative” and “disease” misleading. Let me explain.
The term degenerative refers to the disc in your spine that is degenerating but does not apply to symptoms worsening. Pain associated with degenerative disc disease (DDD) usually does not progress and can even get better over time. Another misnomer regarding DDD is that it is referred to as a disease but it is actually a painful condition resulting from disc damage. Although DDD may occur more often in older people because of use and abuse over the years, the younger group may also develop this condition.
What Causes DDD?
When explaining the causes of DDD, it helps to understand a little about the anatomy of your spine. In between each one of your discs there are pillow-like cushions known as discs. They are important because they help your back carry weight and allow it to move. As you age the discs in your spine become thinner, lose their elasticity and are no longer able to absorb shock. The characteristics of the discs change from being soft and fluid to stiff and rigid, restricting your movement and causing pain.
There are many stages your discs go through as you develop DDD as you can see in the illustration. Notice that some discs may bulge, herniate, or thin which may cause bone spurs (osteophytes) to form as your spine tries to adjust to the changes. Simply stated, as you age, your discs change, your bones are affected, and you experience pain. It is similar to a domino effect, one thing happens, which leads to another, causing more degeneration, and so on.
What If You Think You Have DDD?
It’s easy to think you have DDD especially if you suffer with pain in your back or neck. The important thing is to know where the pain is located, whether it is chronic or a sudden flare up, and what you have done to make it better or worse. For instance, you may notice patterns in your activities that cause more pain sitting for long periods, bending, lifting, or twisting. You may have less pain when walking, running, lying down, or if you change positions often.
Typical questions your doctor will ask you are: 1) when the pain started, 2) what activities you have recently done, 3) what you have taken for pain relief, and 4) is the pain localized or does it travel to other parts of your body.
DDD can develop in any part of your spine but it is most common in your lower back or neck. Knowing when to seek medical attention is very important to your overall health. Here are a few warning signs that will help you decide if you need immediate help:
• Pain is getting worse
• Disabling pain
• Leg weakness, pain, numbness, or tingling
• Loss of bowel or bladder control
You may choose to see a spine specialist who will perform physical and neurological exams to test your reflexes, muscle strength, nerve changes, and pain center. A physical exam will check your posture, range of motion of your joints, and any movement that causes you pain. A neurological exam determines the effect of DDD on your nerves and spinal cord.
There are many other tests your doctor may want to do to diagnose DDD. These include x-rays that are helpful in showing narrowed spinal channels, fractures, bone spurs, or osteoarthritis. You may also be asked to get a flexion and extension x-ray to evaluate the stability of your spine and range of motion of your joints. Sometimes a CAT scan or MRI may be required to show the soft tissues in your spine that identify bulging or herniated discs.
Additional tests may be required to diagnose DDD.
• Bone Scan: A test to detect spinal problems such as osteoarthritis, fractures, or infections related to DDD. By injecting a very small amount of radioactive material into a blood vessel your doctor will be able to figure out where the problem is by focusing on the hot spots; areas with more radioactive material has collected.
• Discogram or discography: A procedure used to confirm or deny the disc as the source of your pain. Harmless dye is injected into one of your discs and if there is a problem such as a herniated disc, it will be apparent.
• Myelogram: A test to see if you have a spinal cord disorder. Dye is injected into the area around your spinal cord and nerves followed by an x-ray or CT scan. This will produce a detailed picture of your spine, especially the bones, to pin point abnormalities.
As you can see, there are many helpful tests and scans that assist your doctor in finding the cause of your pain. There may be reasons why you are experiencing pain or developing DDD. It could be that someone in your family has degenerative disc disease and you are pre-disposed to the condition. Remember too that how you live your life plays into DDD. Smoking, for example, decreases the amount of water in your discs which makes them less able to absorb movement.
See your doctor if your pain persists or travels to other parts of your body. Know when to seek medical attention and be careful not to put too much stress and strain on your back. Take care of your body and it will take care of you for many years to come.
Marc Bromson, M.D.