andre panagos MD

Degenerative disc disease is part of the normal aging process. In many people, it is painless, but in some individuals, it can result in severe debilitating pain. Starting  around the mid-30s, the gel within the disc breaks down, which results in a progressive deterioration of the adjacent bone, muscles, joints and ligaments. This process increases your risk of pain. Genetic inheritance can account for 50-70% of  disc degeneration variability which means that even with extreme care, you cannot escape your family history. High or repetitive mechanical loading and smoking are  thought to play a significant role in the development of pain. Degeneration of the normally avascular intervertebral disc allows blood vessels and nerves to penetrate the disc which introduces inflammatory mediators into the area. Intervertebral disc injuries never fully heal, so continued inflammation causes increasing pain.

 

The symptoms of degenerative disc disease can vary widely. The most common symptoms are:

• Painless progression to severe back pain

• Progressive weakness

• Loss of flexibility

• Muscle spasms

 

Other diseases that can mimic degenerative disc disease include:

• Fracture

• Infection

• Neoplasm

• Stenosis

 

Treatments

Treatment will depend on the source of pain. Treatments may range from simple physical therapy to targeted injections for diagnostic and therapeutic purposes. For less severe pain, a course of non-steroidal anti-inflammatory medicines (NSAIDs) and physical therapy may be helpful. For more severe pain, trigger point injections for symptoms of myofascial pain or epidural steroid injections may be more helpful.

 

References

Benoist M. Natural history of the aging spine. Eur Spine J. 2003 Oct;12 Suppl  2:S86-9.

Kirkaldy-Willis WH, Wedge JH, Yong-Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine. 1978 Dec;3(4):319-28.