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    • Larry L. Teuber, M.D.
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Degenerative Disc Disease

As some of us age, the discs can become brittle and lose their resiliency. The vertebra can in turn compress the space normally occupied by the disc. In some cases, this compression can affect the nerve roots that travel off the spinal column, causing pain. The discs serve as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease often occurs in the discs in the lower back (lumbar) and the neck (cervical), however it can take place throughout the spine. Surgery may be required to restore the space between the vertebra. The surgeon may have to wedge a piece of bone in between the vertebra to restore the disc space.

Possible Causes

As part of the normal aging process, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people.

The loss of fluid in your discs reduces the ability of the discs to act as shock absorbers and reduces flexibility. The reduction in fluid also results in thinner discs and narrower distance between the vertebrae.

Small tears or splits in the outer layer (annulus or capsule) of the disc may cause the jellylike material inside the disc (nucleus) to be forced out through the tears or cracks in the capsule. Which may cause the disc to bulge, break open or break into fragments.

People who smoke, those who do heavy physical work and those who are obese are more likely to have symptoms of degenerative disc disease. An abrupt injury leading to a herniated disc (such as a fall) may also begin the degeneration process.

Symptoms

• Back or neck pain
• An irritated disc in the neck area may result in neck or arm pain
• An irritated disc in the lower back may result in pain in the back, buttocks, or leg
• Pain may worsen with movements such as bending over, reaching up, or twisting
  
  

Diagnostic Methods

Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps your doctor understand your back and neck pain, and the influence of your lifestyle in contributing to your pain. During your physical exam, your neurosurgeon examines your spine and neurological system to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.

X-rays

The first step is usually a set of X-rays. X-rays show the bones (vertebrae) of the spine.

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) uses a magnetic field and radio waves to generate highly-detailed pictures of the inside of your body. The MRI depicts soft tissues of the muscle and discs as well as nerves. These images help your neurosurgeon provide a more accurate diagnosis. This type of imaging is very safe and usually pain free. In most cases, injections are not required. However, in some situations, a contrast agent may be needed to enhance the ability of the MRI to see into your body.

Myelogram Followed by CT

A myelogram determines any decreases or blockages in the flow of cerebral spinal fluid (CSF) around your spinal column. It is used to diagnose a bulging disc, tumor or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into your lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected and a series of X-rays taken. Once the myelogram is completed, you are sent for a CT scan.

Intrathecal CT Intrathecal CT determines blockages or flow of cerebral spinal fluid around the spinal column. A local anesthetic is injected into the lower back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected. This procedure is followed by a CT scan, which takes a series of detailed pictures of the spinal area.

Electrodiagnostics

Electrical testing of the nerves and spinal cord may be performed before, during and after surgery. These tests, called Electromyography (EMG) or Somato Sensory Evoked Potentials (SSEP), assist your neurosurgeon in understanding how your nerves or spinal cord are affected by your condition.

Bone Scan with SPECT

Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also accurate for finding lesions for biopsy or excision. The uses of single-photon emission tomography (SPECT) techniques contribute significantly to the diagnostic accuracy of the scan. A small amount of radioactive material (tracer) is used to visualize all the bones in your body. Approximately three hours after the tracer has been injected into a vein, a scan takes place.

Discography

Discography is a procedure used to determine the internal structure of your disc. It is performed by using a local anesthetic and injecting a dye into your disc under X-ray guidance. An X-ray and CT scan are performed to view the appearance of the disc composition to determine if its structure is normal or abnormal. In addition to your disc appearance, your doctor will note if you have pain with this injection.

Treatment

Ice or heat (whichever feels better) to relieve pain, use nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen, or naproxen sodium. Acetaminophen may also help relieve pain. Dietary supplements or medications may be recommended to treat degenerative disc disease that is linked to osteoporosis. Further treatment depends on whether the damaged disc has resulted in other conditions, such as osteoarthritis, a herniated disc, or spinal stenosis. Physical therapy and exercises for strengthening and stretching the back are often recommended, and in some cases surgery may be recommended.