A condition favoring pathologies such as disc protrusion or disc herniation, degenerative disc disease can be associated with painful symptoms in the back, the precise location of which varies in relation to the location of disc wear (eg: if the intervertebral discs subject to wear are lumbar, the patient may experience pain in the lumbar portion of the back).
For the diagnosis of degenerative disc disease, the following are essential: the patient's report of symptoms, physical examination, medical history and magnetic resonance imaging of the spine.
Reserved only for symptomatic cases, the treatment of degenerative disc disease can be conservative (first-line therapeutic choice) or surgical (therapeutic choice adopted only in case of failure of conservative treatments).
Brief review of the spine
The backbone of the body, the vertebral column or rachis is a bone structure of about 70 centimeters (in the adult human being), which includes 33-34 irregular bones; stacked on top of each other and joined together by means of the so-called intervertebral discs, these irregular bones are the known vertebrae.
VERTEBRA
Three characteristic elements can be recognized in a generic vertebra, which are:
- The vertebral body, in an anterior position;
- The vertebral arch, in the posterior position;
- The vertebral hole. It is the opening resulting from the particular arrangement of the vertebral arch with respect to the vertebral body.
The set of vertebral holes of all the vertebrae constitutes the so-called spinal canal; the spinal cord is housed in the spinal canal.
INTERVERTEBRAL DISCS
An intervertebral disc is a circular fibrocartilaginous structure, which contains within itself a gelatinous substance, called nucleus pulposus, and the cartilage tissue that surrounds the aforementioned nucleus pulposus, that is the so-called fibrous ring.
In addition to providing for the junction of the adjacent vertebrae, the intervertebral discs have the task of absorbing, by means of the nucleus pulposus, the shocks and loads that weigh on the vertebral column. In other words, with their particular content, the intervertebral discs perform the function of shock absorbing pads.
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and responsible for changes in composition and structure (loss of water, deformations, etc.).
Did you know that ...
The water present in the intervertebral discs is essential to guaranteeing the latter their cushioning function.
The loss of water by the intervertebral discs, therefore, makes these structures less able to absorb shocks to the spine.
Causes and contributing factors
Causes and risk factors of degenerative disc disease include:
- The aging process of the human body. As previously stated, as we age, the intervertebral discs are inevitably subject to a degenerative phenomenon, which deprives them of part of the water they contain.
- Daily activities and the constant practice of sports that are a source of stress or minor injuries to the intervertebral discs.
- A history of spinal injuries.
It is asymptomatic when the wear on the intervertebral discs is slight and affects sections of the vertebral column that are not particularly critical as regards the supporting action of the human body; on the contrary, it is symptomatic, when the wear of the intervertebral discs is important or concerns portions of the vertebral column with a more relevant role for the human body than others.
Back pain characterizes the symptomatic forms of degenerative disc disease; this pain has a different location, depending on where the intervertebral discs affected by the condition in question are located; in practical terms, this means that a degenerative disc disease with cervical seat will produce a pain in the neck; a degenerative disc disease with a thoracic site will induce pain in the middle section of the back; finally, a degenerative disc disease with lumbar seat will cause pain in the lumbar area of the back (low back pain).
Did you know that ...
Degenerative disc disease is more often an asymptomatic condition than a symptomatic condition.
Characteristics of Pain associated with Degenerative Disc Disease
The pain produced by degenerative disc disease is a sensation that:
- It gets worse when the patient assumes a sitting position, for an extended period of time.
Experts have observed that the sitting position involves an increase in the load on the spine and this represents a cause of suffering for the intervertebral discs that are no longer perfectly healthy; - Worsens when the patient bends or twists his back;
- Worsens when the patient lifts a weight, especially if he does not flex the lower limbs);
- It improves when the patient is in motion (ex: during a walk or a brisk walk). It may seem strange, however it is so;
- Improves when the patient is lying down;
- It alternates moments in which it is very intense with moments in which it seems to have almost disappeared;
- If it affects the lower spine, it can be combined with:
- Pain in the buttocks;
- Pain in one or both thighs
- Numbness, tingling and / or muscle weakness along one or both lower limbs.
- If it affects the upper area of the spine, it can be associated with:
- Pain in one or both shoulders
- Pain in one or both arms
- Pain in one or both hands
- Numbness, tingling and / or muscle weakness along one or both upper limbs.
FACTORS FAVORING THE PRESENCE OF SYMPTOMS
To favor the appearance of symptoms in a context of degenerative disc disease are factors such as: obesity (involves an extra load on the spine), incorrect postural behaviors, lifting heavy objects by putting weight on the back instead of flexing the legs and excessiveness sedentary lifestyle.
WHAT DO numbness, tingling and muscle weakness depend on?
In a context of degenerative disc disease, the presence of numbness, tingling and / or muscle weakness in the limbs is due to the compression that a particularly worn and deformed intervertebral disc can exert to damage the nearby spinal nerves.
Complications
As anticipated, degenerative disc disease is a predisposing factor for disc bulging and disc herniation, two pathologies of the spine related to each other, as the first can represent the prelude to the second.
- Disc bulging: is the crushing of an intervertebral disc, which causes it to slip out of the hypothetical axis resulting from the normal overlapping of the other intervertebral discs.
In disc bulging, the fibrocartilaginous structure of the intervertebral disc is intact and this is essential for maintaining the nucleus pulposus and the fibrous ring within the intervertebral disc itself. - Disc herniation: with this expression, doctors identify the escape, from its natural location, of the nucleus pulposus contained within the intervertebral disc.
Unlike what happens in the bulging disc, in the herniated disc, the fibrocartilaginous structure of the intervertebral disc is damaged and for this reason the nucleus pulposus can escape.
CONSEQUENCES OF DISC BULGING AND DISC HERNIA
The bulging disc and, in particular, the herniated disc worsen the symptoms (especially the pain) to the point of making it an obstacle to the execution of the most trivial daily activities (eg: taking the stairs, getting on or off the car, devote yourself to housework, etc.).
The obstacle that these spinal diseases cause to daily life represents, for the subjects involved, a reason for low mood, if not downright depression.
- Absence of sensitivity in the limbs
- Severe muscle weakness in the limbs
- Lameness
- Loss of bladder or anal sphincter control
When to see a doctor?
A symptomatology such as that found in the presence of degenerative disc disease deserves an "immediate medical evaluation, when:
- Despite the rest, the symptoms worsen rather than improve;
- There was a sudden and unreasonable worsening of symptoms;
- Symptoms worsened after violent trauma to the neck or back;
- In addition to the classic painful ailments, the patient also complains: loss of control of the anal sphincter or visceral sphincter, complete absence of sensitivity, etc.
- Neurological evaluation: helps to clarify aspects such as: health of the spinal nerves, site of nerve compression, severity of the deformation, etc .;
- Electromyography: consists in the study of the conduction of nerve signals along the anatomical area showing tingling, numbness and / or muscle weakness.
- The administration of corticosteroids. Corticosteroids are powerful anti-inflammatories, with an important analgesic action. Due to their serious side effects, however, they are used only when NSAIDs or paracetamol are not very effective.
- Massage therapy. It is a practice indicated for relieving pain.
- Control / abolition of behaviors that favor spinal pain. For example, a patient suffering from obesity must follow a slimming treatment, while an excessively sedentary patient must practice regular physical activity.
Statistics show that, if the patient is careful in following him, a good conservative treatment for bulging disc has evident benefits, in terms of symptoms, after about 6 weeks from the beginning of the treatment.
Surgical therapy
In a context of degenerative disc disease, surgical therapy is classified as a treatment reserved for the circumstances for which conservative therapy has been completely ineffective, after 2-3 months of its application.
In practice, the surgical treatment of degenerative disc disease consists of a procedure called discectomy, which involves the removal of a damaged or no longer functional intervertebral disc, followed by its replacement with a sort of prosthesis.
From the operative point of view, the discectomy is a complex procedure, because it requires the incision of an extremely delicate area of the body, given the dense network of nerves, ligaments and blood vessels present.
The complexity of the discectomy is the reason why doctors only practice it in severe cases or when conservative remedies have proved completely ineffective.
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