Dr. Wolfe has been in the practice of pain management since 1992.

- MidOhio PainCare

Degenerative Disk Disease

What Is Degenerative Disk Disease?

Degenerative disk disease is the drying out and weakening of the spinal or intervertebral disks. This may cause the disks to bulge or tear. It may cause the disk to irritate nearby nerve roots. It may cause back pain and leg pain depending on the severity. Symptoms may not always correlate with the amount of degenerative disk disease seen on X-ray or MRI.

What Causes Degenerative Disk Disease?

Degenerative disk disease is a normal part of the aging process. As we get older, our spinal disks lose
their flexibility, elasticity, and shock absorbing properties. The fibrous outer portion of the disc, called the
annulus fibrosis, becomes brittle and is more prone to tearing. Also, the soft gel center of the disc, called
the nucleus pulposus, starts to dry out and shrink. The combination of damage to the spinal disks, the
development of bone spurs, and a gradual thickening of the ligaments that support the spine all
contribute to degenerative arthritis of the spine.

What Are The Symptoms Of Degenerative Disk Disease?

Not everyone who has degenerative changes in their spinal disks has pain. Many people who have no
symptoms have MRI examinations that show disc herniations, degenerative disk changes, and narrowed
spinal canals. Every person is different. It is important to realize that not every person with degenerative
disk changes as seen on an MRI and x-ray films develops symptoms.

When degenerative disc disease becomes painful or symptomatic, it can cause several different
symptoms. These symptoms include pain and weakness that results from compression of the spinal
nerve roots. The painful symptoms develop when worn out disks do not function as well as they once
did, and as they shrink, the space available for the nerve roots also shrinks. As the disks between the
vertebrae start to wear out, the entire spine becomes less flexible. As a result, people complain of pain
and stiffness, especially towards the end of the day.

Furthermore, the less flexible degenerative spine is more susceptible to injuries. When a degenerative
spine is subject to loads that it can no longer handle, the disc can tear; bulge or herniate through a tear
and irritate nerve roots, which then can become swollen and inflamed and result in leg symptoms.

What Are Some Nonsurgical Treatments For Degenerative Disk Disease?

In the absence of severe or progressive nerve involvement, the doctor may prescribe nonsteroidal
anti-inflammatory drugs, such as aspirin, naproxen, ibuprofen, or others to reduce inflammation and
relieve pain. Analgesics, such as acetaminophen, tramadol or narcotics may be prescribed to relieve
pain. The doctor may order physical therapy to maintain motion of the spine, strengthen abdominal and
back muscles, and build endurance, all of which help stabilize the spine. Some patients may be
encouraged to try an exercise program or aquatics. Corticosteroid injections into the epidural space may
be performed to reduce inflammation and treat severe pain that radiates to the hips or down a leg. If the
patient has a positive diskogram for back pain, some patient may undergo heating or shrinking of the
disk in an effort to avoid more major surgery.

When Should Surgery Be Considered?

In some cases, the symptoms of degenerative disk disease cannot be controlled by nonsurgical treatment. Sometimes the symptoms can be controlled by non-surgical treatment but does not last a sufficient period of time to justify continued efforts at controlling symptoms. Spine surgery might be considered immediately if a patient has numbness or weakness that interferes with walking, impaired bowel or bladder function, or other neurological involvement. Otherwise, the effectiveness of nonsurgical treatments, the extent of the patient's pain, the patient's overall health status and the patient's preferences may all factor into whether or not to have surgery.

The purpose of surgery for degenerative disk disease is to relieve pressure on the disks, spinal cord or nerves. Surgery may also be directed at trying to restore and maintain alignment and strength of the spine. This is done by removing, trimming, or adjusting diseased parts that are causing the pressure or loss of alignment. The most common surgery for degenerative disk disease is called a spinal fusion. It involves the removal of the lamina (roof) of one or more vertebrae to create more space for the nerves, removing portions or all of a disk, and placing bone or hardware to fuse or secure the vertebrae above and below the disk. A neurosurgeon or orthopaedic spine surgeon may perform a spinal fusion. A recent development has been an artificial disk replacement that will preserve motion of the spine to some degree. A limited number of approved surgeons are performing this surgery.