Degenerative Disc Disease

Degenerative disc disease is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. It typically begins when small tears appear in the disc wall, called the annulus. These tears can cause pain. When the tears heal, they create scar tissue that is not as strong as the original disc wall. If the back is repeatedly injured, the process of tearing and scarring may continue, weakening the disc wall. Over time, the nucleus (or center) of the disc becomes damaged and loses some of its water content. This center is called the pulposus, and its water content is needed to keep the disc functioning as a shock absorber for the spine. When the disc is unable to act as a cushion, the nucleus collapses. As a result, the vertebrae above and below this damaged disc collapse or slide closer together. This improper alignment causes the facet joints (the areas where the vertebral bones touch) to twist into an unnatural position. In time, this awkward positioning of the vertebrae may create bone spurs. If these spurs grow into the spinal canal, they may pinch the spinal cord and nerves (a condition called spinal stenosis). Consequently, the spine may be painful, and the entrapment of the nerves may result in shooting pain and/or weakness of the extremities.

This condition can develop as a natural part of the aging process. With aging and repetitive injury to the back, the disc may lose fluid and become dehydrated, causing a loss of the normal shock absorber function of the disc. These age-related changes can lead to disc herniation, spinal stenosis, scoliosis, instability (spondylolisthesis), and bone spurs, which can put pressure on the spinal cord and nerve roots. 

Degenerative disc disease can occur in the neck (cervical spine) and back (lumbar spine). 

Symptoms of cervical degenerative disc disease include numbness, tingling, and weakness to the shoulders, arms, forearms, and/or the hands. 

Symptoms of lumbar degenerative disc disease include numbness, tingling, and weakness to the low back, buttocks, groin, thighs, legs, and/or feet. 

Sitting upright puts the most pressure on the disc and may worsen symptoms, while lying down tends to relieve the pain.

During your consultation, Dr. Ball will ask you questions about your medical history and your symptoms. He will ask you where the pain started, which part of your spine hurts, if the pain has spread to other parts of your body, if you have had past spine injuries, and if you have a family history of similar problems.  

Dr. Ball will also conduct a physical examination, looking for signs of pain in your lower back or neck, and asking you to walk or bend to see which movements cause pain. He will test your strength, sensation, and reflexes to focus his precise diagnosis of your condition. Imaging studies may be ordered to confirm your diagnosis, which will then allow for the correct treatment recommendations.

Nonsurgical treatment options for degenerative disc disease include 

• Physical Therapy. Exercises help to strengthen your neck and back muscles to make them more flexible and supportive of your spine. 
• Anti-Inflammatory Medications (e.g., ibuprofen, Motrin, Aleve). These medications are recommended to help reduce inflammation, ease pain, and lessen swelling. 
• Prescription Medications. Different medications may be prescribed for muscle spasms and for pain relief.  
• Interventional Pain Treatments. Procedures may be done to place medication next to areas of disc or nerve inflammation or to ablate sensory nerves that may cause pain. These are typically done in surgery center settings with live x-ray for accurate intervention. 

There are several surgical treatment options available for degenerative disc disease. These may include:

Discectomy. In this procedure, the herniated portion of a vertebral disc is removed to help take the pressure off your nerves.

Laminectomy. During a laminectomy, also called a decompression, Dr. Ball removes any bone, bone spurs, or ligaments that are putting pressure on the nerves. The back part of the vertebra, called the lamina, is also removed. This procedure is often recommended for patients who have arthritis of the spine, and have bone spurs developing along the vertebrae adding pressure along the spinal cord. 

Artificial Disc Replacement. In this procedure, the whole disk is removed and replaced with an artificial, motion-preserving device. This is not a fusion.

Spinal Fusion. If you have instability or deformity such as scoliosis, Dr. Ball may fuse (permanently connect) the bones in your spine after he removes the disc.

After surgery, the recovery process can vary based on the type of procedure done. Procedures involving a spinal fusion will typically have longer recovery times, as it can take weeks to months for the bones to completely fuse together. Generally, most patients are able to return to all normal activities within a few weeks of surgery, while the soft tissue and bony healing are taking place.  Physical therapy is usually part of the postoperative treatment plan for most procedures, and this typically runs for four to six weeks after surgery.

If you would like to schedule an appointment with Dr. Ball to discuss treatment options for degenerative disc disease, call CalSpine MD at (925) 667-3745. You may also Request An Appointment online.