Degenerative Disc Disease 101: Ask the Expert

1. What is Degenerative Disc Disease (DDD) and what causes it?

Degenerative disc disease is when the disc between the vertebrae in the spine begins to lose its ability to stay hydrated and begins to collapse. This is often painful and can result in significant disability. The causes are multi-factorial but there has been some correlation with smoking, genetics, obesity, trauma, and some lines of work.

2. What are the common symptoms of DDD?

The common symptoms of DDD often begin with either neck or back pain. It is a degenerative condition so there is often morning stiffness. Motion can be painful, but the level of pain can diminish as the body warms up. The pain can often be exacerbated by prolonged sitting, standing, or holding our heads in fixed positions. This pain can be described as central neck or back pain, but can radiate into the shoulders, lower back, and buttocks. As DDD progresses, the disc space collapses and bone spurs may occur, which can cause pressure around the nerves. This can result in radiculopathy, which is pain that radiates down the arms or legs.

3. How is DDD diagnosed?

DDD is diagnosed by a patient’s history, physical exam, and imaging. By listening to the patient’s story, what types of activities cause pain, as well as what makes the pain level better or worse will help pin-point where and why the patient is having pain. A detailed physical exam can help determine the source of pain by testing the patient’s range of motion, strength and sensation, and where on their neck or back they are most tender. In addition to the history and physical exam, imaging studies are a necessary tool to corroborate the clinician’s diagnosis. Standing radiographs are typically done to help determine the areas of disc degeneration, the number of vertebrae involved, and if there is any instability. An MRI scan is often ordered next to help determine what could be causing pressure on the nerves and the extent of disc degeneration.

4. What are the treatment options for DDD?

The non-operative options include physical therapy, anti-inflammatory medications, oral steroids, steroid injections, and a short course of narcotic pain medicine and anti-muscle spasm medicine. Ergonomic adaptations, activity modifications, and weight loss may also alleviate a patient’s symptoms.

There are many non-operative options for DDD that should be thoroughly exhausted before surgery is considered.

Surgery should only be considered after 8-12 weeks of extensive non-operative care has been exhausted or in the case of progressive weakness and dysfunction. In well-selected patients and proper expectations, surgery may be beneficial and very successful. Most importantly, a patient should expect and request that their treatment plan is individualized.

Read more articles from The Spine Health Journal here.

by Douglas G. Orndorff, M.D. Spine Colorado