Degenerative Disc Disease
Degenerative disc disease (DDD) refers to gradual deterioration of the intervertebral discs between the vertebrae. DDD is a misnomer as it is not actually a disease but a condition that affects the strength, resiliency and structural integrity of the intervertebral discs due to advancing age, trauma, injury, repetitive movement, improper posture, or poor body mechanics. DDD is commonly seen in individuals over 50 years of age. Most of them are usually not aware about their condition until they are examined for some other related health condition.
The intervertebral disc is composed of an inflexible ring called the annulus fibrosis which encloses a gelatinous inner structure called the nucleus pulposus. The discs are kept in position with the help of endplates between two vertebral bodies. The intervertebral discs act as shock absorbers.
As we age, the rate at which the old, worn out cells are replaced is gradually reduced, resulting in the degenerative changes in the discs which can also be accelerated by injury or trauma.
These structural changes can cause a sequence of other changes, resulting in nerve compression and pain due to reduction in the disc height, and presence of bone spurs or bony overgrowths (osteophytes). Other conditions such as spinal stenosis and osteoarthritis (spondylosis) can also affect the intervertebral joints and spinal stability.
The degenerated disc may cause severe pain. Degeneration of the disc can also lead to osteoarthritis condition of the facet joints which is detected on X-ray imaging. It may also be associated with severe pain and stiffness due to muscle spasm and inflammation of the involved spinal nerves.
For diagnosing degenerative disc disease a complete medical history of the patient including the details of previous injuries, medical conditions, family history and any specific symptom is essential. Patients are then physically examined for determining the source of pain. The diagnostic imaging techniques such as X-ray, MRI scan and CT scan may also be employed to distinguish the different conditions such as tumors, herniated disc, nerve compression and other disorders, which may be responsible for DDD.
Non-surgical methods are usually the initial line of management. However, if these are not beneficial surgery may be recommended. The modality of treatment depends on the age of the patient and also on the type and severity of the underlying disorder.
The non-surgical treatment includes rest, physical therapy, chiropractic therapy, medication and self care which involves proper sitting or standing posture, lifestyle modification, sleeping habits and healthy diet.
Surgical is considered after the non-surgical approach fails to be beneficial in relieving symptoms such as pain, numbness and disabled movement. The objective of the surgical treatment is to fix the degenerated disc segments and decompress the involved spinal nerves. Surgical procedures such as spinal fusion, spinal discectomy and intradiscal electrothermal therapy (IDET) are available for treatment of degenerative disc disease.