Degenerative disc disease is a condition in which natural, age-related wear-and-tear on a disc causes pain, instability, and other symptoms. Disc degeneration is most common in the neck (cervical spine) and lower back (lumbar spine), because these areas of the spine involve the most motion and are placed under the most stress.
A degenerating disc does not always cause symptoms to develop. Changes to spinal discs are a natural result of aging, and over time everyone will experience some changes in their discs. The effects of those changes vary greatly among inpiduals. However, it is important to note that disc degeneration can lead to, or accelerate, the onset of additional spinal conditions, such as:
- Spinal Stenosis: degeneration that causes nerve root or spinal cord pinching as a result of the a narrowing of the space occupied by the spinal cord
- Osteoarthritis: degeneration that results in changes to the facet joints in the spine
- Spondylolisthesis: occurs when one vertebral body slips forward onto another due to facet joint degeneration
- Scoliosis: abnormal curvature of the spine
The most common symptoms of degenerative disc disease is a low-grade, continuous pain around the degenerating disc that occasionally flares up into a more severe, potentially disabling pain. Painful flare-ups can often be related to recent activity and stress placed on the spine, but they can also be sudden and without an obvious cause. Painful flare-ups can last from a few days to a few weeks before going away or returning to a low-grade level of pain. Other symptoms include:
- Increased pain with activities involving bending, twisting, or lifting.
- Radiating pain that is often described as a sharp, stabbing, or hot feeling around the degenerating disc. Radiating pain from cervical disc degeneration can be felt in the shoulder, arm, or hand (cervical radiculopathy). Radiating pain from lumbar disc degeneration can be felt in the hips, buttocks, or down the back of the leg (lumbar radiculopathy).
- Muscle spasms or muscle tension caused by spinal instability.
- Increased pain from holding certain positions, such as sitting or standing for long periods of time.
- Reduced pain when changing positions frequently.
- Decreased pain with certain positions, such as sitting in a reclining position or lying down with a pillow under the knees.
Symptoms resulting from a degenerating disc in the neck or spine are not always the result of the deteriorating disc, but rather a result of how the degenerating disc affects other structures within the spine, such as muscles, joints, or nerve roots. Pain associated with degenerative disc disease generally stem from two main factors:
- Inflammation: Inflammation caused by a degenerating disc can cause swelling in the surrounding spinal structures and can result in muscle tension, muscle spasms, and local tenderness in the neck and spine. If a nerve root becomes inflamed, pain and numbness may radiate into the arm and shoulder (known as cervical radiculopathy), or into the hips or leg (known as lumbar radiculopathy).
- Abnormal micro-motion instability: as a spinal disc degenerates, the cushioning and support provided by the disc decreases and causes small, unnatural motions between vertebrae. These micro-motions cause tension and irritation to the muscles, joints, and nerve roots. As the disc continues to degenerate the affected spinal segment becomes more unstable, resulting in intermittent episodes of more intense pain.
The majority of people with degenerative disc disease experience pain in the lower back that flare up periodically, and symptoms typically do not get worse over time. The main goal is to manage the pain caused by degenerative disc and to stop more damage from occurring. Treatment will vary based on your symptoms and the seriousness of the condition. Some non-surgical treatment options include:
- Medications: over-the-counter pain relievers like aspirin and ibuprofen can help reduce inflammation and ease pain levels. Degenerative disc disease can cause muscle spasms and muscle tension, so your physician may suggest medication to address these symptoms.
- Physical Therapy: specific exercises help strengthen muscles that support the neck and spine, which can reduce pain and improve range of motion. Stretching also helps promote better range of motion in the spine and helps reduce lower back pain. In most cases, physical therapy and over-the-counter medication are enough for long-term pain relief.
- Steroid Injections: are used to control localized inflammation in the spine by flushing out any additional fluid in the spine causing the pain.
- Hot and Cold Therapies: help manage inflammation and promote recovery after exercise or activity.
For a small percentage of people, surgery may be considered if conservative treatment options fail. For people with ongoing severe and/or disabling pain, muscle spasms, and associated symptoms (numbness, tingling, and difficulty sitting or standing for long periods) your physician may recommend surgical intervention. Surgery is typically considered if patients meet the following criteria:
- Patients have tried non-surgical treatment options and an exercise-based physical therapy program.
- Significant pain persists with an inability to control symptoms.
- Patients experience limited ability to function in everyday activities.
The most common surgery for degenerative disc disease is either a spinal fusion or artificial disc replacement. Recovery time following surgery is typically one to three months. For the first four to six weeks following surgery, patients should limit their activity to only walking, sitting, and physical therapy. During this time, it is important for patients to avoid bending, twisting, and lifting anything over 10 pounds. After six weeks, patients can begin to increase their activity level.