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Lumbar Degenerative Disc Disease

What is Lumbar Degenerative Disc Disease?

Degenerative Disc Disease (DDD) is the result of wear and tear on the spine over time. Gravity, motion and weight-bearing combine to take a toll on the spine. While the development of DDD is normal and expected, some patients will develop this process earlier in life or to an extent beyond what would be expected.

At what age do patients get Lumbar Degenerative Disc Disease?

Some patients have signs of DDD as early as their 20’s whereas it would usually not be expected until they reach their 30’s or 40’s. Similarly, some patients have 3 degenerated discs in their 40’s, whereas widespread DDD like this would not be expected until their 70’s.

Do all patients with Lumbar Degenerative Disc Disease have pain?

It is important to know that just because someone has signs of DDD on an X-Ray, does not mean they have to have pain. Studies have shown that up to 1/3rd of patients in their 40’s will have some signs of DDD on an MRI, yet only a small fraction of them will complain of any symptoms. Overall, 25% of the population under the age of 40 who do not have symptoms, have evidence of degenerative disc disease on an MRI scan. 60% of the population over the age of 40 who do not have symptoms, have findings of degenerative disc disease on an MRI scan.

How does a Lumbar Disc Degenerate?

At birth our disc contains 80% water. The water content of the disc can be a measure of its ability to function appropriately as a shock absorber. Starting in our 3rd decade of life, we begin to lose some of this water content. Also, some of the important proteins which make up the core of the disc (nucleus) diminish. They are often replaced by collagen (a tough fiber) which does not attract much water to the disc. As a result, the disc gets progressively harder in nature, and subsequently loses its function as a shock absorber. Another consequence of this process is the loss of the height of the disc. This is one of the reasons why we lose height as we age.

At the same time, the disc’s outer ring (annulus fibrosus) becomes more brittle and less elastic. It can develop cracks and begin to bulge outward potentially causing spinal stenosis.

Do Degenerated Discs cause bone spurs?

When a disc degenerates and gets harder, the top and bottom sides (endplates) of the respective vertebrae above and below the diseased disc encounter more resistance. Rather than pushing against a soft shock absorber they begin to grind against a harder material. Eventually this can lead to bone spurs which develop as a result of bone coming into contact with hard material. This stimulates bone growth, which grows bone spurs. Depending on their location, these bone spurs can cause irritation or compression of spinal nerves or the spinal cord.

Does Lumbar Disc Degeneration cause joint pain as well?

When a disc loses its height and function, the facet joints in the back of the spine are often also affected.

Each spinal segment consists of two vertebrae with a disc in between them and two facet joints in the back of the spine. Since the disc has motion, it can be thought of as a joint as well. In essence then, the disc and the two facet joints form a triangle, each representing a mobile joint.

As a consequence, degeneration and loss of height at the “disc joint” will have an effect on the facet joints. Specifically, as the disc loses height, more and more weight is transferred from the “disc joint” to the facet joints. This causes significant stress over time and often results in degeneration of the facet joints.

Who is at risk for developing Lumbar Degenerative Disc Disease?

The following are people at risk for developing DDD.

  1. Smokers
  2. People exposed to significant vibration such as driving a vehicle for a living
  3. Genetics. DDD tends to run in families through genes passed from one generation to the next.
  4. Patients with a history of spine trauma
  5. Patients of advanced age
  6. Patients with obesity

What symptoms do patients with Lumbar Degenerative Disc Disease have?

Symptoms from DDD can vary depending on the degree of DDD and which other structures are affected by it. Classically, DDD is felt as pain the center of the spine. It often radiates to the sides of the spine. This pain is often worse with physical activities and while remaining in one position for longer periods of time. It may also be accompanied by a sensation of stiffness in the spine. Resting the spine often improves the symptoms. Symptoms of DDD typically slowly worsen over time, but can also level off at some point.

When a disc loses height during the process of degeneration, the spinal nerve can be compressed causing leg pain.

Here again are the common symptoms of Lumbar Degenerative Disc Disease:

  1. Low-back pain
  2. Low-back muscle spasms
  3. Loss of spine mobility
  4. Low-back stiffness

How do spine specialists diagnose Lumbar Degenerative Disc Disease?

A history and physical exam can be helpful in pointing towards DDD, but imaging studies are typically the best way to make a diagnosis.

  1. History

The patient’s history may point at genetics, smoking, obesity, or physical work, which predispose the patient to DDD. Prior injuries or disc surgery can also be a red flag.

Low-back pain which has gradually gotten worse and causes stiffness and muscle spasms is suggestive of DDD.

  1. Physical Examination

Lack of spinal mobility and pain with forward bending can point towards DDD.

Here are some common examinations done to evaluate a patient for Lumbar DDD:

  1. Range of motion (mobility)
  2. Palpation (touch and pressure) of the spine
  3. Sensation testing of the legs
  4. Muscle (motor) testing of the legs
  5. Reflex testing of the legs
  6. Gait testing

      3. Imaging

a. X-Rays

X-Rays provide a good view of the bone anatomy of the spine. It is also useful to evaluate the height of a disc between the vertebrae. The loss of disc height on a plain X-Ray is usually the first indication of DDD. In later stages, the tops and bottoms (endplates) of the vertebrae next to the degenerated disc will appear flatter and may have bone spurs (osteophytes). Similarly, the facet joints in the back of the spine may show enlargement of the bones (articular processes) making up the joint. The facet joint space will also diminish.

b. MRI

MRI imaging can be very useful in evaluating the disc itself to assess the degree of degeneration. The hydration left in the disc can be seen on particular MRI views. The impact of the DDD with on the other structures of the spine such as the spinal cord, spinal nerves, and ligaments can be seen directly.

c. CT scans

CT scans are best used to evaluate bone anatomy. The disc itself can be difficult to evaluate on a CT scan. However the effect of DDD on the adjacent vertebral bodies and joints (facet joints) can be seen.

What treatments are offered for Lumbar Degenerative Disc Disease?

DDD does not have to be a painful disease. Many patients have few or occasional symptoms. The following are some treatment options for those who do have symptoms:

  1. Non-Surgical Care

A. Alternative Health Care

Alternative Health care options can often complement conventional medical care. Massage Therapy, Acupuncture, Meditation exercises and Herbal Remedies can all help with the pain from this condition. Massage Therapy techniques can help with the muscle discomfort of thoracic degenerative disc disease.

B. Nutrition and Weight Loss

Proper nutrition and weight loss can have a positive impact on many spine conditions. Excess weight on the spine often contributes to the symptoms of pain and spasms (Spine and Obesity).

C. Chiropractic Care

Chiropractic care including manipulation and adjustments of the spine can help with the pain and spasms from this condition.

D. Spine Exercises

Spine exercises can help with the muscle pain and tightness from this condition. Exercise also increases the amount of oxygen delivered to the spine which can help with healing. Pilates, Yoga and T’ai Chi can help maintain the spine’s flexibility. Exercising the spine can be a form of “preventative maintenance” over time. The focus should be on spine mobility and stability.

E. Physical Therapy (PT)

PT has many modalities to offer for this condition. They can range from Manual Therapy and Exercises to Traction and Ultrasound Treatments. PT can be helpful for DDD. Keeping the spine’s mobility, strength and stability are often goals of PT. Spine traction can be a useful treatment in early DDD. As the disease progresses, the disc and its spine segment may stiffen to a point where traction may not be helpful any longer.

F. Self Help Tools

Self Help Tools are items which can be purchased to help with back pain. They range from Back Braces to Back Mattresses and Ergonomic Devices such as chairs and computer accessories. Sometimes back braces can add stability to the spine. However this must be balanced against relying too much on the brace, which could weaken the muscles over time.

G. Spine Medications

Similar to other spine conditions, medications which help with spine pain can help with the symptoms of DDD. While there is no “best medication”, the spine specialist can prescribe one or a combination of the medications below. Here are some examples of groups of medications:

  1. Non-Steroid Anti-Inflammatories Drugs(NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
  4. Nerve Pain Medications
  5. Antidepressants

H. Injections

Spine injections can frequently be helpful for pain from DDD. In some patients, the disc or spinal nerve becomes inflamed. In this scenario, epidural steroid injections can help relieve the inflammation and pain. In other patients, the spine joints (facet joints) become inflamed when the disc degenerates.

These joints can also be treated with injections. In other patients, the spine muscles become tight and painful. Muscle injections for these chronic spasms may also be effective.

Here are some of the injections used for lumbar DDD:

  1. Lumbar Trigger Point Injections
  2. Lumbar Muscle Blocks
  3. Lumbar Interlaminar ESI
  4. Lumbar Transforaminal ESI
  5. Lumbar Nerve Root Block
  6. Lumbar Facet Joint Injection
  7. Lumbar Medial Branch Block
  8. Lumbar Radiofrequency Rhizotomy of the Facet Joint


      2. Surgical Care

Surgical care for DDD is reserved for patients who have severe symptoms and a poor quality of life. An isolated disc segment may respond better to a surgical treatment than multiple segments of DDD. Here are some potential surgical treatment options of Lumbar DDD:

  1. Minimally Invasive Spine Surgeries:
  1. Mini-Transforaminal Lumbar Interbody Fusion
  2. Axial Lumbar Interbody Fusion
  3. Interlaminar Lumbar Instrumented Fusion

      2. Open Spine Surgeries

  1. Lumbar Fusion
  2. Lumbar Artificial Disc Replacement
  3. Lumbar Dynamic Stabilization