Overview Degenerative disc disease commonly occurs with age, as discs become
more brittle, less resilient and more prone to herniation. Degenerative
disc disease is the single most common diagnosis related to serious
back and neck pain. When a disc herniates in the spine, the surgeon
can sometimes simply remove a portion of the disc. In other cases,
where the disc is more damaged and must be removed, something must
be placed into the disc space. Otherwise, the two vertebrae will
collapse on top of one another, placing pressure on the nerve roots
that branch off from the spinal cord.
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Causes Some of the contributing factors of degenerative disc disease are family
history, lifestyle and age. The prime age for disc-related problems
is after 35. If a parent had back or neck surgery for a herniated
disc, you should be particularly concerned about taking care of your
back. Lifestyle is another important factor. Those who perform frequent
lifting or put themselves in situations where the spine is exposed
to trauma or repetitive shock can also develop degenerative discs
over time.
Osteoporosis can lead to disc degeneration. As bones weaken, a person
becomes increasingly at risk for vertebral fractures.
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Symptoms Degenerative disc disease makes the back more prone to injury and can
contribute to the following conditions:
Diagnosis Outlined below are
some of the diagnostic tools that your physician may use to gain insight
into your condition and determine the best treatment plan for your
condition.
Medical history: Conducting a detailed medical history
helps the doctor better understand the possible causes of your
back and neck pain which can help outline the most appropriate
treatment.
Physical exam: During the physical exam, your physician
will try to pinpoint the source of pain. Simple tests for flexibility
and muscle strength may also be conducted.
X-rays are usually the first step in diagnostic
testing methods. X-rays show bones and the space between bones.
They are of limited value, however, since they do not show muscles
and ligaments.
MRI (magnetic resonance imaging) uses a magnetic
field and radio waves to generate highly detailed pictures of the
inside of your body. Since X-rays only show bones, MRIs are needed
to visualize soft tissues like discs in the spine. This type of
imaging is very safe and usually pain-free.
CT
scan/myelogram: A CT scan is similar to an MRI in that it provides
diagnostic information about the internal structures of the spine.
A myelogram is used to diagnose a bulging disc, tumor, or changes
in the bones surrounding the spinal cord or nerves. A local anesthetic
is injected into the low back to numb the area. A lumbar puncture
(spinal tap) is then performed. A dye is injected into the spinal
canal to reveal where problems lie.
Electrodiagnostics: Electrical testing of the nerves
and spinal cord may be performed as part of a diagnostic workup.
These tests, called electromyography (EMG) or somato sensory evoked
potentials (SSEP), assist your doctor in understanding how your
nerves or spinal cord are affected by your condition.
Bone scan: Bone imaging is used to detect infection,
malignancy, fractures and arthritis in any part of the skeleton.
Bone scans are also used for finding lesions for biopsy or excision.
Discography is used to determine the internal structure
of a disc. It is performed by using a local anesthetic and injecting
a dye into the disc under X-ray guidance. An X-ray and CT scan
are performed to view the disc composition to determine if its
structure is normal or abnormal. In addition to the disc appearance,
your doctor will note any pain associated with this injection.
The benefit of a discogram is that it enables the physician to
confirm the disc level that is causing your pain. This ensures
that surgery will be more successful and reduces the risk of operating
on the wrong disc.
Injections: Pain-relieving injections can relieve
back pain and give the physician important information about your
problem, as well as provide a bridge therapy.
Treatment A typical solution for problems related to DDD is a spinal
fusion procedure.The main problem with fusion surgeries is that
they don't often turn out well. While some studies claim a success
rate of about 75 percent, that still leaves one in four surgeries as
not successful. The second problem with fusion surgery is that there is a reduction in mobility that can cause other problems over time. Because the fusion locks a vertebral segment from rotating, it causes more stress on the level above and below the fused site, which in turn can herniate these other discs. Thankfully, there is an alternative today—artificial
disc implantation.
Dietary supplements or medications may be recommended to treat degenerative
disc disease that is linked to osteoporosis.
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FAQ What is degenerative disc disease? A natural byproduct of aging is the loss of resiliency
in spinal discs and a greater tendency for them to herniate, especially
when placed under a weighty load, like when we lift heavy objects.
Additionally, some people have a family history of degenerative disc
disease, which increases their own risk of developing it. When a natural
disc herniates or becomes badly degenerated, it loses its shock-absorbing
ability, which can narrow the space between vertebrae.
Who is a candidate for the artificial disc? Patients with a diseased disc between L4 and L5 or between L5 and S1
(all in the lower back) that is worn out or become injured and causes
back pain are candidates for the artificial disc. Other candidates
include those with degenerative disc disease (DDD) whose bones (vertebrae)
have moved less than 3mm. Your physician will help you determine
whether or not the artificial disc is a good choice for you. Factors
that will be considered include your activity level, weight, occupation
and allergies.
What are the benefits of the artificial disc? Generally speaking, those who receive artificial
disc replacements return to activity sooner than traditional fusion
patients. Also, because there is no need to harvest bone from the patient’s
hip, there is no discomfort or recovery associated with a second
incision site. Some of the overall benefits of artificial disc surgery
include:
Retains movement and stability of the spine
Prevents degeneration of surrounding segments
No bone graft required
Quicker recovery and return to work
Less invasive and painful than a fusion
Reduces pain associated with disc disease
While the artificial disc may well be a promising new technology,
most spine surgeons today are very cautious. There are many serious
concerns including:
Constantly changing technology as new discs are coming out that
last longer and may be easier to insert and remove
The lifespan of the implants are in question
What happens if the implant needs to be removed
Consult with your spine surgeon to determine your best option. Click
here to learn more about the artificial disc.
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