Degenerative Disk Disease

Description

Degenerative disk disease results from weakening of one or more intervertebral disks. These disks provide a shock absorbing function to the spinal column. They run almost the whole length of the spine and consist of a central fluid part, known as the nucleus pulposus and a circumferential outer portion consisting of collagen fibers. The outer portion is called the annulus fibrosus. Whether through age-related wear and tear or injury, small tears in the annulus fibrosus are characteristic of degenerative disk disease. The tears can progress to the point that the nucleus pulposus leaks out and irritates the surrounding nerves. As the disk degenerates, it begins to lose its ability to serve as an effective cushion between the bones of the spinal column.

Causes

  • Age-related wear and tear
  • Trauma

Symptoms

Localized pain that:

  • Presents in the lower back, gluteal area or thighs
  • Is intermittent with episodes lasting days to months
  • Worse with sitting
  • Worsens with bending, lifting and twisting
  • Improves with walking
  • Improves with lying down

Diagnosis

Diagnosis begins with a careful history and physical examination performed by a physician. The back is examined for range of motion and flexibility. The physician will check your reflexes and muscle strength to look for signs that are suggestive of nerve root involvement.

X-rays can show narrowing between the vertebral bodies, a sign that the disk has degenerated or even collapsed. The x-rays may also show bone spur formation on the edges of the joints and bones of the spinal column.

An MRI scan or CT may be ordered to evaluate the changes in the spine more carefully. An MRI can show disk herniations and nerve root compression. A CT scan is useful for a careful examination of the bony structures of the spinal column. It can be used to assess how much space nerve roots have to exit from the spine.

Management

For patients without nerve root compression and muscle weakness, conservative management with medication, rest, exercise and physical therapy is appropriate.

Chiropractic therapy is another option in this scenario.

If conservative therapy does not result in significant improvement, interventional pain management techniques are an option. These include:

  • Transcutaneous electrical nerve stimulation
  • Trigger point injections
  • Epidural steroid injections
  • Intradiscal injections
  • Facet injections
  • Radiofrequency ablation
  • Intradiscal electrothermal treatment
  • Nucleoplasty

Surgery is reserved for patients who fail conservative management and interventional pain management.