Degenerative Spinal Disease

Degenerative Spinal Disease Overview

Degenerative spinal disease (also known as degenerative disc disease) is a common cause of low back and neck pain. It is actually more a condition than a disease. It refers to degenerative changes in the low back (lumbar spine) or in the neck (cervical spine) that can affect its structure and/or function.

A number of other spinal disc changes are also associated with low back pain. These include bulging disc, sciatica, osteoporosis and fibromyalgia, among others. The condition is mostly frequently associated with aging but it can (rarely) occur in young people.

The back is made of bones, muscles and other tissues that form the posterior of the body’s trunk—from neck to pelvis. The spinal column supports the weight of the upper body. It also houses and protects the spinal cord, which carries signals controlling body movement and sensation.

The spinal column is made of 26 individual bones (known as vertebrae) that are stacked on top of one another. The vertebrae are maintained by round, spongy pads of cartilage (discs) that permit the back to be flexible and cushion the bones as the body moves.

Aging, wear and tear and other conditions cause the discs to lose their fluid and become thinner, more rigid and less flexible. The degenerative changes cause reduced movement and pain. The degenerative process can also be started by a strain or injury. Disc degeneration can contribute to other back problems including spinal stenosis, osteoarthritis of the spine and Spondylolisthesis.

Wellstar neurologists and neurosurgeons are expert in diagnosis and treatment of degenerative spinal disease. Whether you are experiencing slight discomfort or extreme pain, our doctors will recommend strategies and procedures to improve your comfort and quality of life.

Symptoms

Degenerative spinal disease symptoms may develop slowly over time. Well before any sign of the condition appears on an X-ray, the spine may already be undergoing important changes.

The primary symptom is neck or back pain. The location of pain depends on the area of the spine that has degenerative changes. In some cases pain in one area of the spine will radiate or migrate to another area of the body. That’s because the nerves that branch off the spine travel throughout the body.

People with spinal degeneration have pain that can range between slightly annoying to disabling. Other symptoms include:

Severe episodes of back or neck pain lasting from a few days to a few months before returning to less pain.
More pain when sitting for a long period, bending, twisting or lifting.
Less pain when walking or running.
Less pain when body position is frequently changed.
Less pain lying down.

If any of the following symptoms occur, seek help immediately as these may indicate a situation that requires prompt medical attention. For example, a protruding disc wall or other material may be pressing on the spinal cord or irritating a nerve root. Watch for:

Worsening or disabling pain.
Weakness, pain, numbness or tingling in the legs
Loss of bladder or bowel control.

Risk Factors

Risk factors for degenerative spinal disease include:

Age. Degenerative disease typically occurs between age 30 and 50, and the risk increases with age. Aging contributes to wear and tear on the discs that support the vertebrae of the spine. In some cases children who carry overly heavy backpacks have been affected.
Sedentary lifestyle.
Traumatic injury.
High-impact sports.
Some occupations that require heavy lifting.
Genetics seems to play a role in the pace at which the condition develops.

Degenerative Spinal Disease Prevention

Because degenerative spinal disease is closely linked with aging, there is not much you can do to prevent it. But there are certain precautions that can reduce the chance that the condition will worsen or will lead to other conditions.

Stop smoking if you do smoke and don’t start.

If you are overweight, begin a weight loss program, as extra weight can speed up the degenerative process.

Stay active to help slow the process of disc degeneration. Stretch regularly and get regular, low-impact exercise by walking, biking or swimming. Exercise can help maintain flexibility and mobility and control weight.

Avoid long periods of sitting without getting up, as degenerated discs can be more painful while sitting.

Avoid slumping forward, which puts pressure on the discs of the lower back.

Lift with caution. Hold the object close to your body. Use your knees, not your back for a safer lift.

Talk with your Wellstar physician about seeking the assistance of a Wellstar physical therapist. Our skilled therapists can design a personalized program of exercise to reduce or eliminate pain.

Degenerative Spinal Disease Diagnosis

Diagnosing degenerative spinal disease can be challenging, as the condition typically develops quite gradually. Also, it can be related to or accompanied by a number of other conditions including herniated or bulging discs. If you have persistent back or neck pain visit your WellStar neurologist or neurosurgeon who can help identify the cause of the pain and develop an effective treatment plan.

The diagnosis process includes a physical examination to assess your overall health as well as your physical condition, posture, flexibility and ability to move certain joints. The doctor will feel your spine to better understand its curvature. He or she will ask questions about the pain—when it began, what activities you have been doing, what makes it feel better and worse and whether the pain stays in one place or travels to other locations in the body.

A neurological exam will be conducted to assess your reflexes, muscle strength, spread of the pain and nerve changes. The purpose is to determine whether the degeneration is affecting nerves or the spinal cord.

Tools and Tests

Wellstar physicians use a variety of tests that image the spine and show areas of degeneration. Among these:

X-ray permits the doctor to visualize the bones of the spine from a variety of angles.
Flexion and extension x-rays reveal range of motion and spine stability. You will be asked to briefly bend forward and backward as the films are taken.
Computerized tomography (CT) or magnetic resonance imaging (MRI) scans can show more than x-rays, including the soft tissues of the spine and the bones and nerves.
Electromyography (EMG) measures how your nerves respond to changes in the spine.
Bone scan helps detect spinal problems related to degenerative disc disease.
Discography is a procedure that confirms or eliminates a disc or discs as the source of pain. Dye is injected into a disc and any problems will show up on an x-ray.
Myelogram (different from EMG) uses dye injected into the area around the spina cord and nerves to look for nerve compression or other spinal canal problems

Degenerative Spinal Disease Treatment

In the past, long periods of bed rest including lumbar traction were commonly recommended for patients with degenerative spinal disease. Wellstar physicians agree with research that has led to a more updated approach that may include rest during the first, acute phase of pain, followed by a program of stretching, appropriate exercise and other activity-based treatment. Although degenerative disc disease is quite common, it does not typically require surgery.

Non-medication treatment options:

Activity modification—taking steps to avoid making the condition worse—is often a first step. For example, you may be advised to not lift heavy objects or avoid playing sports that require back rotation such as golf, basketball and football.
Therapeutic exercise including stretching can improve flexibility and widen the openings in the spinal cord through which nerve roots pass. Other exercises focus on muscles and ligaments to help maintain the natural curve of the spine. No or low-impact aerobic exercise builds strength and coordination. Working in partnership with your doctors, Wellstar physical therapists can help develop an exercise program tailored to your specific needs and preferences.
Heat and ice applied to stiff joints and muscles can increase flexibility and range of motion. Ask your doctor or physical therapist for details depending on your specific symptoms.
Alternative therapies like acupuncture and chiropractic manipulation can help relieve back pain in some patients by increasing range of motion, reducing muscle tension and removing pressure from sensitive nerves. Ask your Wellstar physician about these and other options.

Medications

Your doctor may prescribe prescription medications including the following:

Pain relievers
Anti-inflammatory agents to reduce swelling
Muscle relaxants
Spinal injections that introduce steroid medication directly to the painful area
Antidepressants
Sleep aids

Your doctor may recommend non-prescription (over the counter) medications including non-steroidal anti-inflammatory agents (NSAIDs) like ibuprofen and naproxen) and pain relieves like acetaminophen (Tylenol). Follow your doctor’s recommendation for these, as there is a risk of side effects.

Surgery

If you have been unsuccessful with non-surgical treatments for six months or more it may be time to discuss surgery with your Wellstar neurosurgeons. The presence of certain symptoms, like loss of bladder or bowel control due to nerve root compression, may indicate that surgery is required immediately. The type of surgery—and what you can expect—depend on your precise diagnosis, symptoms, location of the degenerated discs and your overall health. Generally, patients who do not smoke and who are not obese have better spinal surgical outcomes.

Traditional surgery has focused on (1) removing the discs or parts of discs pressing on nerves, known as decompression surgery and (2) fusing the spine to control movement, known as stabilization surgery. Often these processes are done at the same time.

Your neurosurgeon will discuss the various options for decompression and stabilization. These include procedures that remove facet joints, bone spurs and all or part of the lamina, the bony plate that protects the spinal cord. When the lamina presses on the spinal cord it can cause significant pain. These techniques are performed from the back of the spine (posterior).

Other decompression surgeries are performed from the front of the spine (anterior) because the spinal cord is in the way. One option is a discectomy, using a minimally invasive approach with tiny tools and a shorter recovery period. Another option is corpectomy or vertebrectomy, which involves removing more of the vertebral material.

Wellstar neurosurgeons also offer a relatively new procedure that involves removing a degenerated disc and replacing it with an artificial disc. This technique gives the patient more mobility than a standard decompression (fusion) surgery. Artificial discs are not appropriate for all patients and there are certain risks, as with any surgery. Ask your doctor about these so that you can make an informed decision.

Ongoing Care for Degenerative Spinal Disease

Many people who have degenerative disc disease lead active and productive lives with minimal pain and discomfort. Following tips for a healthy lifestyle can help reduce your discomfort or, in some cases, may prevent degeneration from getting worse.

Stop smoking or don’t start.

Follow a diet rich in fruits and vegetables to maintain a healthy weight. Wellstar offers weight loss programs and the services of licensed dietitians who can help you learn what foods to eat and develop a food plan tailored to your needs.

Get regular exercise. If you’re not sure what exercises are right for you, talk with your doctor who may recommend you visit a Wellstar physical therapist.