FAQs on Degenerative Disc Disease (DDD)
Degenerative disc disease (DDD) affects more than 90% of people 65 years of age and older. DDD is weakening of one or more of the vertebral disc, which are positioned between each vertebra of the spine. Developing as a natural part of the aging process, DDD may also result from injury to the back and is a source of chronic back pain. The presence of abnormal disc pathology is associated with a 2-fold incidence of chronic low back pain.
What are the symptoms of DDD?
Degenerative disc disease can cause pain in the back, buttocks, and/or thighs, which comes and goes and is worse with sitting, bending, or twisting. Many patients report numbness and tingling of the legs. The tingling in the lower extremities results from nerve impingement, where the nerves of the spine are inflamed, pinched, or crowded. If the cervical (neck) discs are affected, the arms may go numb and tingle, whereas the legs are affected with degenerative discs of the lumbar (low back) region.
What causes degenerative disc disease?
The cause of degenerative disc disease is injury. Inflammation of the disc occurs as the body attempts to heal the injury. Swelling from the inflammation can irritate nearby nerves, and as white blood cells rush to the area, they die eventually, leaving behind debris.
When the nerve endings along the spine are affected by this inflammatory process, pain occurs. In addition, the disc wall tears from wear-and-tear and/or injury, resulting in scarring. Over time, the outer layer weakens, and the jelly-like center (nucleus) of the disc loses its water content.
When this happens, the disc no longer has the cushioning ability it once had, causing the vertebral bones to touch and twist in an unnatural position. If bone sports form, they can grow into the spinal canal, pinching the cord and nerves, which is referred to as spinal stenosis.
How is DDD diagnosed?
A definitive diagnosis of degenerative disc disease requires x-rays and a magnetic resonance imaging (MRI) scan. Before these tests are done, the doctor will conduct a physical examination and ask several questions about your pain and condition. He/she will also check your spine and extremities range of motion, assess reflexes, and evaluate muscle strength.
How is degenerative disc disease treated?
There are several treatment options for degenerative disc disease. While there is no cure, therapy is aimed at relief of pain and associated symptoms. Treatment options include:
- Medications – For mild back pain without serious associated symptoms, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen.
- Physical therapy – Many patients who have DDD find relief with physical therapy. The therapist teaches the patient strengthening and flexibility exercises, and uses heat, massage, and ultrasound to relieve symptoms.
- Epidural steroid injection (ESI) – The layer of tissue outside of the spinal cord is called the epidural. Into the space between the epidural layer and spinal cord, the doctor injects a long-acting steroid using x-ray guidance. According to clinical research reports, the success rate for transforaminal ESI is around 85% or more. In another study, cervical interlaminar ESI showed strong evidence for short-term relief of back pain.
- Lumbar sympathetic nerve block (LSNB) – The doctor injects a long-acting anesthetic agent near the sympathetic nerves of the lower back. After this, a neurolytic substance (phenol or alcohol) is injected to destroy a portion of the nerve. Recent clinical studies show effectiveness of this block to be 70%, with little effect on motor and sensory function.