Degenerative Disc Disease: What Is It & What Are My Options?

Degenerative disc disease is a common cause of back pain and/or neck pain. The location of the pain depends on the location of the problematic discs. Usually, the ones that cause pain are the lumbar discs (lower back) and the cervical ones (neck pain).

Spinal discs are the soft, compressible elements that act like a cushion between the bony vertebrae of your spine. When these discs start to break down, it can lead to pain.

This process is often a misunderstood condition.

Degenerative means that the disc’s condition typically gets worse over time. It DOES NOT mean that symptoms will necessarily get worse over time. Sometimes the back pain can actually improve with age.

Disc is pretty straight-forward. This is the “cushion-like”, cartilaginous material between the bony vertebrae of your spine. You can think of them as the shock absorbers of your spine.

Disease can also cause confusion because this is a misnomer. This is not a disease, but a condition. This degenerative condition can produce, from time to time, pain from a damaged disc.

Disc degeneration is, unfortunately, a natural part of the aging process. Over time, all of our discs undergo degenerative changes. What is different is that not everyone gets symptoms from these degenerative changes.

As we age, our discs begin to break down, or degenerate.

The discs begin to lose their natural fluid. This makes them less flexible and less able to function as shock absorbers. This also makes the disc thinner, narrowing the distance between vertebrae.

Tiny cracks and tears can also develop within the outer layer of the disc. This can cause the disc (with its soft center) to bulge, or rupture, or fragment, or lead to other problems (mentioned below).

To better understand what’s going on, we need a bit of information about the disc itself. A spinal disc is sometimes compared with a jelly donut because it has a tough, outer layer and a softer, gel-like inner layer.

Annulus Fibrosus: Tough, Outer Layer

The disc has very little nerve supply and these nerves usually penetrate only into the outer parts of the annulus fibrosus. Back pain can develop, however, if a tear in this part of the disc reaches those nerves. And with continued degeneration, those nerves can grow deeper into the disc and cause more pain.

Nucleus Pulposus: Softer, Gel-like Inner Layer

This part of the disc contains many inflammatory proteins. If they come into contact with the nerve roots of the outer layer, it will cause pain.

Keep in mind that spinal discs have a limited blood supply. This means that when injury occurs, there is a limited way in which the body can deliver oxygen and nutrients to try to repair and restore the damaged disc. This is in direct contrast to muscles, which have a much better blood supply and can heal much better.

To recap, where does pain come from in degenerative disc disease?

1. Inflammation (like the scenarios described above)

2. Micromotion Instability

What the heck is micromotion instability? When the outer parts of the disc becomes damaged, it no longer does one of its jobs very well. And that is the job of resisting motion in the spine. This is what’s referred to as “micromotion instability” because this is typically not associated with gross instability of the spine.

Both of these processes, the inflammation and micromotion instability, can result in muscular spasms of the low back. This is the body’s natural response to try to “stabilize” the area. And it can be quite painful!

A Cycle of Pain: The Degenerative Cascade

When injury occurs to a disc and the degenerative process begins, there appears to be 3 stages to this process.

1. There can be considerable pain and dysfunction caused by the acute injury.

2. There is a longer phase of relative instability at that vertebral level. The patient is susceptible to “on and off” bouts of back pain.

3. The body eventually re-stabilizes that area. The patient experiences fewer episodes of back pain.

Who is at higher risk?

Certain factors contribute to a higher risk for developing these disc problems. They include:

1. Cigarette Smoking

2. Obesity

3. Heavy-duty Physical Work (repeated, heavy lifting)

Additionally, a sudden injury (like a fall) can cause a herniated disc that accelerates this process.

So you can see how this can get a bit tricky. Pain can start after a major injury, like a car or motorcycle accident. It can start after a minor injury, like a fall from a low height. It can be triggered following a normal motion, such as bending or twisting. Or it can start gradually, without any known triggering event.

Sometimes, you can experience numbness or tingling in the arms or legs.

Making a Diagnosis

Your physician will start with a detailed and focused medical history and physical examination.

They will want to know about your symptoms, any injuries and illnesses, any activities that makes the pain worse (or better), any previous treatments and their effectiveness, etc.

During the physical exam, they’ll check the affected area for:

• Range of Motion
• Pain with movement
• Look for tender areas
• Do a neurologic exam looking for muscle weakness, numbness, tingling, and changes in reflexes
• Assess for other possibilities (infection, tumors, fractures, etc)