Degenerative Disc Disease
For most people with lower back pain, an injury doesn’t just happen. Instead, over the years, the stress your back has been subjected to begins to take its toll. The repeated sprains, strains and overuse add up and cause a slow degeneration of the discs of the spine.
Most episodes of lower back pain are at least partially the result of these degenerative changes. In some cases, an acute injury can cause the pain, but even then the overall condition of the lumbar spine is very important since it usually determines how fast you will recover from the injuries and whether you risk the condition becoming chronic.
Degenerative disc disease means wear and tear changes in the disc. Nearly everyone has signs of degeneration of lumbar discs after age 40, although some people show evidence of changes much earlier. In lumbar degenerative disc disease, lifting or twisting can aggravate the pain. While most of the pain is felt in the lower back, there are cases where it can radiate down the back of one leg. This happens when the sciatic nerve is involved.
As the vertebrae shift, pinching and irritation of the nerve root can happen. Our muscles begin to tighten and spasm in an attempt to stop the painful spinal segment from moving. Eventually, the disc can get inflamed and that starts to hurt too.
In the late stages of spinal degeneration, bony spurs from the degenerative process can cause spinal stenosis. In this condition, the spinal canal becomes too small and presses on the nerve roots causing pain and nerve dysfunction in the legs.
Degenerative disc disease is a result of the normal aging process, as the discs lose their blood supply after age 30. Their water content also diminishes, predisposing the discs to tears. But, it may also occur as a result of trauma, infection, or direct injury to the disc. Heredity and physical fitness may also play a part in the process.
The degeneration process is gradual, with the wear and tear on the vertebrae causing the deterioration. Different types of stress affect the discs as we use our backs each day. The disc generally acts like a shock absorber. Twisting and bending are perhaps the greatest stress on the parts of the spine - especially the disc.
Treatment will focus on management of chronic pain. Non-steroidal anti-inflammatory medications (NSAIDs) or other non-narcotics may be prescribed to manage pain.
South Bend Spine offers physical therapy modalities such as ultrasound and heat that may also help in controlling the pain. An exercise program will be suggested to build up the muscle strength in the back and abdominal muscles. Weight should also be adequately managed, as increased weight on the back causes stress on the vertebrae and only exacerbates the condition.
More severe cases may require more aggressive treatment plan. Chemonucleolysis, a procedure in which an enzyme is injected into the affected area to dissolve the extruded disc material, has been found helpful in some cases. Similarly, surgical treatment, in which either the lamina (a portion of the vertebra) is removed, or the affected disc is removed, may be prescribed.
If spinal stenosis is the cause, you may need a surgical procedure called a laminectomy. The lamina is the back part of your spine that acts as a roof over the spinal column. In a laminectomy, the lamina is removed to give the nerves more room and reduce the inflammation along the nerves.
In the most severe cases of lumbar degenerative disc disease, surgical fusion may be required. If your back problem is caused by segmental instability, a spinal fusion may be needed.
During a spinal fusion, a bone graft, often from your pelvic bones, is put between two or more vertebrae, causing the vertebrae to fuse or grow together. The goal of a spinal fusion is to stop the motion between the two vertebra that comes from the segmental instability.
There are two general types of spinal fusions, posterior fusion and interbody fusion. Both are open surgeries, where an incision is made to expose the affected area. Both have very low complication rates and about 90% of the patients experience pain relief. Some patients may complain of back pain and fatigue, as a result of muscle loss from the operation.
If open surgery is used, the patient will be remain in the hospital for several days and learn how to move properly, how to change positions, sit, stand, and walk. Pain medication will be given the first few days to minimize discomfort and a urinary catheter may be used. In some cases, the patient will wear a back brace for a brief period after surgery.
One technique that has gained much recent attention is the laparoscopic approach because it invades the body less. Only a small incision is made and the hospital stay is often only two days compared to the 4 or more for the traditional techniques. A return to work can even occur in as little as 3 weeks depending on physically demanding your job is. On the other hand, if open surgery is used, the return to work can be anywhere from 3 to 6 months.