Degenerative disc disease

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Degenerative disc disease
Classification and external resources
Cervical Spine MRI showing degenerative changes closeup.jpg
Degenerated disc, C5-C6 with osteophytes
ICD-10M51.3
ICD-9722.6
DiseasesDB6861
 
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Degenerative disc disease
Classification and external resources
Cervical Spine MRI showing degenerative changes closeup.jpg
Degenerated disc, C5-C6 with osteophytes
ICD-10M51.3
ICD-9722.6
DiseasesDB6861

Degeneration of one or more intervertebral disc(s) of the spine, often called "degenerative disc disease" (DDD) or "degenerative disc disorder," is a condition that can be painful and can greatly affect the quality of one's life. Disc degeneration is a disease of aging, and though for most people is not a problem, in certain individuals a degenerated disc can cause severe chronic pain if left untreated.

Symptoms[edit]

With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees, hands, and fingers may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting. Chronic neck pain can also come from the cervical spine, with pain radiating to the head, shoulders, arms and hands. Cervical Arterial Disease or CAD may cause interrupted blood supply to the brain resulting in headaches, vertigo, and the diminution of cognitive abilities and memory.

Understanding disc pain[edit]

After an injury, some discs become painful because of inflammation and the pain comes and goes. Some people have nerve endings that penetrate more deeply into the anulus fibrosus (outer layer of the disc) than others, making discs more susceptible to becoming a source of pain. The scientific community[who?] has the opinion that the healing process involved in the repair of trauma to the outer anulus fibrosus results in the innervation of the resultant scar tissue, and subsequent pain in the disc, as these nerves become inflamed by nucleus pulposus material. Degenerative disc disease can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life. When pain from degenerative disc disease is severe, traditional nonoperative treatment may be ineffective.

Pathologic changes[edit]

Micrograph of a fragment of a resected degenerative vertebral disc, showing degenerative fibrocartilage and clusters of chondrocytes. HPS stain.

Degenerative discs typically show degenerative fibrocartilage and clusters of chondrocytes, suggestive of repair. Inflammation may or may not be present. Histologic examination of disc fragments resected for presumed DDD is routine to exclude malignancy.

Fibrocartilage replaces the gelatinous mucoid material of the nucleus pulposus as the disc changes with age. There may be splits in the anulus fibrosus, permitting herniation of elements of nucleus pulposus. There may also be shrinkage of the nucleus pulposus that produces prolapse or folding of the anulus fibrosus with secondary osteophyte formation at the margins of the adjacent vertebral body. The pathologic findings in DDD include protrusion, spondylolysis, and/or subluxation of vertebrae (sponylolisthesis) and spinal stenosis.

Treatment options[edit]

Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, chiropractic manipulative therapy (CMT) and other chiropractic treatments[citation needed], osteopathic manipulation, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs, traction, or spinal injections often provide adequate relief of troubling symptoms.

Surgery may be recommended if the conservative treatment options do not provide relief within two to three months. If leg or back pain limits normal activity, if there is weakness or numbness in the legs, if it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary, most often spinal fusion. There are many surgical options for the treatment of degenerative disc disease. The most common surgical treatments include:[1]

New treatments are emerging that are still in the beginning clinical trial phases. Glucosamine injections may offer pain relief for some without precluding the use of more aggressive treatment options. In the US artificial disc replacement is viewed cautiously as a possible alternative to fusion in carefully selected patients, yet it is widely used in a broader range of cases in Europe, where multi-level disc replacement of the cervical and lumbar spine is common. Adult stem cell therapies for disc regeneration are in their infancy. Investigation into mesenchymal stem cell therapy knife-less fusion of vertebrae in the United States began in 2006.[3]

See also[edit]

References[edit]

  1. ^ "Degenerative Disc Disease - When Surgery Is Needed". Retrieved 2007-06-26. 
  2. ^ Black W, Fejos AS, Choy DS (October 2004). "Percutaneous laser disc decompression in the treatment of discogenic back pain". Photomed Laser Surg 22 (5): 431–3. doi:10.1089/pho.2004.22.431. PMID 15671718. 
  3. ^ "Mesoblast files spinal fusion IND". Australian Life Scientist. 2006-11-27. Retrieved 2009-02-16.