Degeneration of the intervertebral discs of the spine is termed as Degenerative Disc Disease. With age the intervertebral discs undergo degeneration as part of normal wear and tear of the body. In many people this process does not produce any symptoms; however, in the others it may produce chronic pain with episodic exacerbations occasionally. Discs of the entire spine do get affected but most changes are seen in cervical and lumbar spine, as these areas are most mobile.
Pathophysiology: The normal disc contains a nucleus pulposus in the centre surrounded by annulus fibrosus. With age the nucleus pulposus, shrinks and undergoes many changes. The annulus fibrosus undergoes degeneration and may split thus allowing protrusion of the nucleus pulposus. This can cause nerve root compression. Also there may be secondary osteophyte formation at the margins of the vertebral body. People suffering from Degenerative Disc Disease, are prone to greater damage from the slightest injury. Minimal injury can trigger an acute episode of disc disease.
Symptoms: In symptomatic cases, there may be chronic lower back pain, sometimes radiating to the lower limbs. Pain may be worse on prolonged standing, walking, bending and lifting. There may be tingling, pins and needles sensation in the lower limbs, numbness over the sensory distribution of the affected nerve root. In case of cervical disc there may be neck stiffness, pain and restriction of movement. The pain may radiate to the upper limbs. There will be associated tingling sensation or numbness on the upper limbs. Degenerative Disc Disease, as the name suggests is purely a degenerative condition and is seen in all people as they age. However the intensity and degree of degeneration varies in each and every one. Also the levels of discomfort and symptoms produced vary from one person to another. Many individuals with severe radiological changes in the spine may be completely asymptomatic, while those having very minimal changes on a radiograph may complain of severe pain and discomfort. Thus radiological findings must be correlated clinically in all cases.
Diagnosis: Examination findings are extremely essential to grade the severity and intensity of disc problems. Examination should include grading the degree of local tenderness, spasm of the paraspinal muscles, range of movement, straight leg raising test, sensations over the sensory distribution of the nerve roots, muscle power over the motor distribution of the nerve roots etc. Further tests like x- rays, MRI scans may be required. Also blood tests must be done in order to rule out other causes of back pain like infections, high uric acid etc.
Treatment: Most cases of Degenerative Disc Disease can be treated without surgery. Physiotherapy which includes short wave diathermy, Back stretching and strengthening exercises must be done regularly which help to tone the muscles and prevent worsening of the symptoms. Certain supplements in the form of calcium and vitamin D3 may be administered by the physician. Non steroidal anti-inflammatory drugs may be used depending on the degree of pain experienced. In cases when the pain and symptoms do not subside with conservative treatment, surgery is the only option.
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