Degenerative Disc Disease (DDD) is the gradual wear and tear of the spine and a natural process of aging. It occurs along the entire spine and can be asymptomatic. The intervertebral disc and articular facet joints are most affected by degenerative disease. The disc is composed of a tough outer lawyer that is richly supplied with nerves. This is called annulus fibrous. The inner portion is a soft, jelly-like core called nucleus puposus.This contains proteins that are very irritating to nerve fibers and will cause swelling and pain once it is leaked into surrounding areas upon damage of the disc. The chemical irritation of the nerves causes severe pain associated with degenerative disease.
The aging process causes gradual degeneration of the annulus fibrous which leads to changes in the mechanical structure of the disc. This increases the potential of leakage of chemical contents from inside the disc. The disc gradually loses its normal mechanical and chemical structure and become less resilient to stress. There are also changes in the structure and function of the articular facets. There is hypertrophic changes in the vertebral bodies adjacent to the degenerating disc. These changes are known as osteophytes (bone spurs) that results in shifting of compressive loads from the anterior and middle columns to the posterior elements. Once a disc becomes worn out it is irreparable because of limited blood supply to nourish the disc.
The most prominent symptoms of degenerative disc disease include severe pain to the lower back and the buttocks. A discography is done to diagnosis this condition which gives a more precise location and extent of injury of the disrupted disc. However, diagnosis can be done through MRI and CT scan.
Degenerative disc disease can be treated with non-operative as well as surgical interventions. Non operative treatments performed at our clinics include regenerative medicine protocols such as platelet rich plasma injections into the painful disc with and without the addition of bone marrow concentrate tissue. These treatments can be done as outpatient procedures in our clinics and may avoid the need for more invasive therapies such as a surgical fusion in some cases. NSAID medicationsandother non narcotic agents are excellent in relieving the inflammatory process and physical therapy helps to strengthens the muscles in the back which gives support and relieve pressure from the disc. Steroidal and facet injections may offer prompt relief dependingon the associated pathology of the spine such as age related joint diseases, arthritis. soft tissue and ligamentous damage. Surgical interventions include artificial disc replacement, fusion and microdecompression (dissect a small part of bone that compresses the nerve to relieve pressure) of the lumbar disc.