Mild disc degeneration is a normal part of the aging process and is generally not a problem in and of itself. However, for certain individuals an even relatively mildly degenerated disc may cause pain of varying intensity. DDD is thought to be one of the most common causes of persistent low back pain. Disc degeneration is not technically a disease, but rather a condition in which the discs dry out and shrink very slowly over time. Once discs begin the process of degeneration, potential related problems may arise in the spine due to the shrinkage, e.g. facet arthritis, muscle guarding pain.
What are bulging/protruding/herniated discs?
Common in both younger and older adults, bulging discs are not usually a sign that something serious is occurring. In fact, abnormalities that show up radiologically such as bulging or protruding discs are seen at high rates in many patients, often without causing any back pain at all. Many discs begin to bulge as a part of the normal aging and degenerative process noted above. A disc may become problematic, however, if it bulges or protrudes enough to cause narrowing of the spinal or nerve canals. Bone spurs, if present along with the bulging disc or associated with arthritic facet joints, can also add to the narrowing of these canals. This process is referred to as stenosis and often causes leg as well as back pain.
Lastly, herniated discs are the more extreme version of a protrusion. The jelly like matrix of the disc is ejected from the disc itself and can come in direct contact with the nerve roots or spinal sac/cord. This is a relatively frequent cause of sciatica (leg pain due to “pinched nerve”).
What are the causes of disc disease?
Discs contain about 80% water when we are young. Normally, these intervertebral discs buffer the mechanical stress of everyday movements, much like shock absorbers or cushions. As the body ages, the percentage of water naturally decreases and the discs shrink slightly. The disc spaces can additionally be narrowed by injury. The bony vertebra above and below the disc move closer together, narrowing the disc space between the two and causing the facet joints located at the back of the spine to shift slightly. This improper alignment of the vertebra may cause bone spurs around the disc space and facet joints. Depending upon the degree of degeneration from these processes, bending and twisting movements may be hindered. Evidence suggests that the bone spurs around the dics may be the body’s response to disc injury or degeneration to prevent excess motion at the spinal segment. Bone spurs are therefore felt to be part of the body’s somewhat less than adequate attempt at healing. However, bone spurs can become problematic if they invade the spinal canal by placing pressure on the spinal cord and nerves. This condition is called spinal stenosis as refered to above.
What treatment options are available?
Most scientific evidence suggests that surgery is no more effective in relieving back/sciatica pain than conservative approaches, such as oral medications, physical therapy, and/or occasional steroid injections. Furthermore, TENS, massage therapy, acupuncture, manipulation and craniosacral therapy can all play a role in successful treatment, especially of primarily muscular pain.
An important exception to this approach is the rare massively herniated disc which causes profound leg muscle paralysis and sudden incontinence/buttocks numbness. This is an indication for immediate surgery and the latter is often helpful in this setting.
At PainCare, surgery for disc disease is only recommended as a last resort. Surgical benefit is usually temporary, may cause permanent adhesions within the spine that can often provoke more pain and dysfunction in later years, and frequently promotes instability which leads to fusion operations.
Sometimes it is necessary to verify a particular disc and the primary pain generator because there are a number of potentially painful abnormalities seen on an MRI. Discography, in these instances, may be quite helpful. Once identified, the offending disc may be treated percutaneously (a minimally invasive technique) with heat or radio waves to shrink or alter the sensation of bulging discs, thus reducing pain.
When all reasonable options, as well as surgery, have been exhausted, and severe pain continues, implant technology is considered (such as peripheral neuromodulation, spinal cord/dorsal column stimulation and pumps/spinal catheters).