Spinal discs become worn out and weaker as we age. About 40% of adults over age 40 have at least one degenerated vertebral disc. As adults reach the age of 80, this percentage doubles, which means most people will likely have to deal with disc disease at some point in their lives.
If you or someone you know have been diagnosed with chronic pain due to degenerative disc disease, treatments are available to address your symptoms and improve your quality of life. Some of the most current and effective pain management solutions for disc degeneration are physical therapy, NSAIDs (such as Advil) and epidural steroid injections. If pain management treatments do not provide adequate relief, surgery may be indicated based on your medical history, physical exam(s) and imaging studies such as an MRI.
Your Low Back is Complex
Your spine is an intricate system of working parts. It is made up of vertebrae, which are bones that stack like building blocks and are separated by discs, which serve as cushions between the vertebrae. The components of the vertebrae form a protective case around the spinal canal, which houses a fluid-filled sac containing spinal nerves. These nerves have the important job of carrying signals between the brain and body. Small openings in the vertebrae, called the foramen, are formed by the stacked vertebrae, which provide a way for the nerve to leave the spinal canal. The lumbar spine contains the five bottom vertebrae in the back. These vertebrae are named L1-L5.
The Causes of Degenerative Disc Disease
The constant wear and tear of daily life can weaken vertebral discs over time, making it more prone to damage from sudden movement or injury. If the disc’s soft center begins to bulge, or the outside of the disc tears and the soft center squeezes through, a nerve may become irritated or pinched. This can cause pain, burning, tingling or numbness in the leg. Pressure on a nerve that connects to the sciatic nerve may cause pain in the buttock and down the leg.
Also, as a disc wears out, the vertebrae above and below the disc begin to touch and abnormal bone, called bone spurs, grow. The foramen or the spinal canal can then narrow, causing irritation of a nerve.
Vertebral discs are predominantly made up of water, and as we age the core of the discs gradually lose some water, reducing their ability to provide a cushion to absorb shock. The loss of water in your discs lead to disc space collapse, which can cause increased back pain and nerve pressure.
Diagnosis and Symptoms of Back Pain
One of the primary reasons degenerative disc disease often goes undiagnosed is that the pain is not constant and often comes in waves, causing pain in your neck and back that can last for months at a time and then subside for months at a time. One nearly-universal symptom associated with degenerative disc disease is numbness or tingling in your arms or legs that extends down to your buttock and lower back. Also, if your back and neck pain intensifies when you sit, bend or lift, it may indicate you have degenerative disc disease.
Selecting Your Pain Management Specialist and Spine Surgeon
The diagnosis and treatment for degenerative disc disease can be emotionally and physically challenging for you and your family. The selection of a pain management team, or even a surgical team, is an important part of your treatment plan. Many patients seek a specialist with exceptional clinical training and years of experience. Accessibility, location, insurance, and convenience and comfort for both you and your family are also key considerations. Do not hesitate to ask questions when selecting a pain management specialist. Here are a few questions to ask potential pain management specialists that may help guide your decision.
- What is the clinician’s and team’s overall approach to treatment?
- What experience and training does the clinician have in the diagnosis of degenerative disc disease?
- How is the diagnosis made?
- How is a treatment plan developed and who is involved?
- Where can patients read genuine reviews about the clinician(s)?
Treatment Options for Degenerative Disc Disease
The first course of action for treating degenerative disc disease is implementing conservative measures. Only if these prove unsuccessful is surgery then considered.
NSAIDs are either over-the-counter or prescription strength. Common examples include ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), and aspirin. NSAIDs reduce the body’s production of chemicals called prostaglandins, which trigger inflammation and pain. NSAIDs can have both positive and negative effects and should only be taken under the guidance of a physician. If you are on blood thinners, have kidney disease or other medical conditions, consult with your physician before taking NSAIDs.
Physical therapy and movement changes involve a specific series of stretching and flexibility exercises, strengthening exercises, low-impact aerobic exercises and key movement changes. Physical therapy might sound intense if you are suffering from chronic pain, but good physical therapists know how create an exercise routine that is manageable. Key protective movements that can help protect your vertebrae include:
- Tightening the muscles in your stomach to support your spine.
- Keeping your ears, shoulders and hips in a line.
- Bending at the hips and knees, not your waist.
- Moving your body as a unit and avoid twisting at your shoulders or waist.
Epidural steroid injections are intended to calm the problematic nerve that is affected by the diseased disc. This minimally invasive and low-risk procedure does not correct the structural damage to your spine but can improve inflammation, will usually ease your chronic pain, and improve your quality of life.
Facet joint injections may be effective in relieving pain and inflammation. This procedure involves injecting a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication into the joints on the side of your spine. This non-surgical option may provide pain relief for a span ranging from several days to several months. Up to three injections may be given per year.
Lumbar medial branch blocks are another minimally invasive procedure, used to help identify if your pain is originating from the facet joints. If this is the case, long lasting relief can be provided with a radiofrequency ablation (RFA) of irritated nerves overlying these joints. First, anesthetic medicine is injected around the nerves. If the injection/block provides pain relief, results are considered “positive” and the radiofrequency ablation procedure may be considered. RFA uses an electric current to heat up a small area of nerve tissue to stop it from sending pain signals to the brain.
Spinal Cord Stimulation, also called SCS, uses electrical impulses to relieve chronic pain. It is the belief that electrical pulses prevent pain signals from being received by the brain. The treatment starts with a trial implantation to determine if a SCS is effective for you. If the amount of pain relief is acceptable, a permanent implant is placed and the electric impulses are controlled with an external wireless programmer.
Surgery may be an option if conservative and interventional treatments fail and the pain continues for an extended period. There are many factors taken into consideration when discussing surgical options, which are customized for each patient’s unique needs.
One surgery commonly used for degenerative disc disease is a laminectomy, in which some or all of the lamina is removed from the affected vertebrae. The opening created may be enough to take pressure off the nerve. If needed, the surgeon can also remove any bone spurs or disc material still pressing on the nerve.
Another surgical option is an anterior cervical discectomy fusion (ACDF). In this procedure, the affected intervertebral disc and adjacent bone, if necessary, is removed to take pressure off the nerves and align the spine. This surgery is performed less frequently than a laminectomy.
For the best outcomes, treatment is a partnership between the clinical experts, the care team supporting the physician(s), and you and your family. Patient education videos on degenerative disc disease and information on Sierra Neurosurgery’s conservative and effective approach to treatment can be found at www.sierraneurosurgery.com/surgical-procedures.