Degenerative Disc Disease

Definition

Degenerative disc disease of any part of the spine often reflects wear changes in the individual discs of the spine.

Spondylosis is another term for degenerative disc disease.

Description

On an x-ray, the doctor may see a narrower disc space (spinal stenosis) and some osteophyte (bony outgrowth of spur) formation. As people age, these changes tend to show up on the x-rays of most men and women.

Degenerative disc disease can affect any part of the spine, although common sites are the lumbar (lower back) and cervical (neck) spine.

Lumbar spinal stenosis is the narrowing of the neural canal and foramina to an extent that results in compression of the lumbosacral nerve roots or cauda equina. Acquired lumbar stenosis is caused primarily be degenerative disease of the spine.

Spontaneous or post-traumatic tears, degeneration, fibrosis, and collapse of the disc may lead to failure of mechanical function.

Causes and Risk Factors

Degenerative disc disease can result from trauma (either acute or chronic/repetitive), infection, or the natural processes of aging.

Symptoms

The process of degeneration of the spine may lead to local pain, stiffness, and restricted activity.

Treatment

Conservative non-operative therapy includes nonsteroidal anti-inflammatory medications (NSAIDs) and exercise programs to strengthen abdominal musculature and reduce lumbar lordosis (curvature).

Surgical intervention must be considered when medical management fails to relieve intolerable pain during activities of daily living. It should also be considered in patients with initial signs and symptoms of progressive neurologic deterioration.

Treating a painful, deformed, or unstable spine may require fusion surgery to hold a portion of the spine permanently in a desirable position. A bone fusion must mature for several months before it is secure. During that time, your physician may recommend a device that is affixed to vertebrae (spinal bones) and implanted within the body.

While not all spinal fusions require implants, many patients whose spines are weakened by injury or disease or whose deformities must be corrected are treated with internal fixation.

In a simple fusion procedure, the surgeon joins two or more adjacent vertebrae. Bone taken from other parts of the body, usually the hip, is placed on the other side of the vertebrae. Plugs of bone shaped like hockey pucks are used between the vertebrae. The bones and bone grafts grow together as healing progresses, eventually forming a single unit.

Until the fusion is complete, it is usually necessary to wear a brace or plaster cast. Various types of implants are used depending on the problem that required the fusion, the patient's age, and the surgeons judgment.

Fusion surgery may be inherently more complicated, more painful, and riskier than procedures such as discectomy and laminectomy. There is no consensus in the medical community as to the appropriate indications for fusion surgery. The lack of consensus is reflected in the tremendous variation in fusion surgery rates in different regions of the U.S.

Questions to Ask Your Doctor

What is the problem with the lumbar spine?

Is there significant narrowing and compression?

What treatments do you recommend?

Why is spinal fusion preferable to laminectomy and other procedures?

Will an implant be used?

What are the possible complications?