Degenerative Disc Disease
Between each pair of vertebrae in the spine lies a shock-absorbing cushion called an intervertebral disc. As your body ages, the degeneration of your discs is the result of routine wear and tear. Everything you do while upright tests the spine’s ability to support your body weight and puts pressure on the discs. In addition, many people sustain minor injuries to the disc, which may not cause any immediate pain. Over the years, these repeated daily stresses and minor injuries can add up, gradually causing degenerative disc disease. Although it starts with damage to one or more discs, degenerative disc disease eventually affects all parts of the spine surrounding the damaged area.
Degenerative Disc Disease Symptoms
The most common early symptom of degenerative disc disease is back pain that often spreads to the buttocks and upper thighs. The degenerating discs can also cause discogenic pain, which is pain that originates in a damaged disc or bulging disc.
Potential Causes of Degenerative Disc Disease
Every healthy intervertebral disc has two core components: a gelatinous center (the nucleus pulposus) and an outer ring of tough ligament material (the annulus). The nucleus has a jelly quality that allows it to absorb stress. The tough ligaments of the annulus hold the vertebrae together.
In minor disc injuries that result from daily wear and tear, the annulus is generally first to be injured. For example, the ligament may tear slightly. As these tears heal, scar tissue forms. Since scar tissue is not as strong as normal ligament tissue, as more scar tissue forms, the annulus becomes weaker. This may lead to damage of the nucleus. The nucleus may, for example, lose water content, compromising the disc’s ability to act as a cushion. This reduction in cushioning increases stresses on the annulus, leading to more tears to the ligaments. As this cycle of degeneration continues, the disc’s nucleus may lose all its water. If the nucleus collapses in this way, the space between the vertebrae above and below the degenerating disc will narrow. As a result, the facet joints (located at the back of the spine) will shift, distorting the way these joints work together.
In addition, bone spurs (sometimes called osteophytes) may form around the damaged disc space or the facet joints. These bone spurs are thought to be the body’s natural response, an attempt to stop the excess motion at the affected spinal segment. But bone spurs on the spine can become a problem if they start to grow into the spinal canal and press into the spinal cord and spinal nerves. This condition is called spinal stenosis.
Diagnosing Degenerative Disc Disease
Many things can cause back pain, so your Mount Sinai doctor will begin by conducting a medical history and physical exam. We often use diagnostic tests such as X-rays and magnetic resonance imaging (MRI). If we suspect disc degeneration, we may use X-rays to confirm the diagnosis by showing a decrease in the space between vertebrae, the formation of bone spurs, facet joint hypertrophy (enlargement), or instability when flexing or extending your limbs. An MRI can verify loss of water in a disc, facet joint hypertrophy, spinal stenosis, or a herniated disc.
Degenerative Disc Disease Treatment
Spinal discs degenerate in virtually everyone as they grow older. Often, we can help you feel better with a combination of appropriate exercise, some modification of activities, and physical therapy that emphasizes proper body mechanics.We may prescribe medications such as Motrin or Aleve to reduce inflammation.