Some things are meant to stand the test of time. Unfortunately, our backs aren't always one of them. Gravity is not your spine's best friend. From the moment we roll out of bed, we subject our backs to the forces of standing, walking, sitting, twisting, lifting, bending and any number of complex movements.
It's no wonder back pain is such a relatable condition. “About 80% of adult humans will complain about back pain at some point," says Ryan Seal, MD, with The Christ Hospital Physicians – Spine Surgery. “It's one of the most common diagnoses there is."
Back pain can have many causes, but as we age, it becomes more likely that we might start feeling the impacts of degenerative disc disease. You've probably heard the term, but you might be surprised to know that it's not really a disease at all.
What is degenerative disc disease?
Degenerative disc disease is a condition caused by wear and tear of the discs in the spine. There are roughly two dozen fluid-filled discs that act as shock absorbers between the individual vertebrae.
Those discs are especially vulnerable to injury because they have a limited blood supply. They don't get the steady flow of oxygen and nutrients that other parts of the body get to promote healing. So even tiny tears can lead to scarring within the discs and weakening of the disc wall over time.
“Degenerative disc disease can involve any part of the spine, but it most frequently affects the neck, which is the cervical spine, and the lower back, which is the lumbar spine," Dr. Seal explains.
It's not typical for a single event to cause disc degeneration. Instead, it's usually part of a process or a combination of factors. For example, repeated strain from physical labor, sports, or heavy lifting.
Being overweight can play a role in adding pressure on your discs. Smoking is also terrible for your spine, constricting already tiny blood vessels and robbing the discs of even more oxygen.
As a disc degenerates and starts to collapse, it loses its ability to serve as a cushion. The vertebrae above and below move closer together and can start grinding against each other or pinch the nerves. But not everyone with degenerative disc disease is going to experience pain.
“There are plenty of people who have normal, age-related degeneration of their discs who don't have symptoms. It's abnormal for someone in their 80s to not have degenerative disc disease, but that doesn't mean they all have neck or back pain," Dr. Seal says.
When degenerative disc disease starts to hurt
Back pain from a regular muscle strain or twisting the wrong way might go away on its own, with rest or with an over-the-counter pain reliever like ibuprofen. Pain from degenerative disc disease feels very different.
“Usually it's a deep, aching, gnawing pain," Dr. Seal describes. “It's often associated with lots of bending, twisting, carrying heavy objects or things of that nature."
Dr. Seal points out that back pain is complex, so the source of pain may not always be directly tied to disc degeneration. “Sadly, patients are unable to tell the difference themselves," Dr. Seal says.
There's no single, definitive test to diagnose degenerative disc disease. “It usually requires a good medical history, a physical by a trained physician, and some imaging," Dr. Seal says.
“It tends to be not only disc degeneration, but other factors like arthritis of the joints in the back, a deformity of the back like scoliosis, or a narrowing of the spinal canal (spinal stenosis)," Dr. Seal says. “When there isn't an obvious structural issue, then oftentimes disc degeneration ends up being the cause."
Symptoms of degenerative disc disease can vary from person to person, but common problems can include:
- Pain in the neck or lower back, sometimes radiating into the buttocks and legs
- Pain that feels worse after bending, lifting, twisting or long periods of sitting
- Pain that gets better when walking, lying down, or changing positions
- Numbness or tingling into the arms and/or legs
Non-surgical treatments for degenerative disc disease
There is no cure for degenerative disc disease. Early treatment focuses on managing symptoms, usually with very conservative approaches.
“If you've had back or neck pain for a week, then it usually warrants some rest, anti-inflammatories, and maybe a course of physical therapy," Dr. Seal says. “If it doesn't get better, it warrants further workup, often with imaging."
“We have our Physical Medicine & Rehabilitation specialists and injection specialists who try to treat pain through every possible non-surgical method first," Dr. Seal says. “Usually after a minimum of six months of conservative care involving non-opioid medications, physical therapy, or other pain management solutions like injections is warranted before ever considering surgery."
Surgical treatments for degenerative disc disease
Dr. Seal recognizes that spine surgery is a big decision for patients. It involves weighing all their options once conservative treatments are no longer as effective at managing pain and mobility. “Ultimately, the patient gets to make the decision about their level of pain, their quality of life, and their desires."
Many times, surgery for disc degeneration involves spinal fusion – which adds stability to the spine by fusing injured vertebrae together. But The Christ Hospital also offers minimally invasive techniques to preserve motion.
“The interesting thing about spine surgery is there's often more than one way to do it," Dr. Seal says. “It depends on the patient and their specific anatomy."
Sometimes, the best way to operate on the back – isn't through the back. That's where collaborations with other surgical specialists, like vascular surgeons and ear, nose, and throat surgeons, are opening innovative ways to reach the spine and better avoid the spinal cord and the muscles and blood vessels that support spine health.
“We can go in through the belly or the side through small incisions in a much more minimally invasive way," Dr. Seal says. “When we go through the front or the side, we can remove the damaged disc and fuse the adjacent vertebrae with a cage."
For disc degeneration in the neck (cervical spine), some patients may even benefit from a disc replacement. “It's an implant made of metal and plastic similar to a hip or knee replacement, with the goal to retain motion," Dr. Seal says.
Some common terms your spine surgeon might share with you to describe various surgical options include:
- Discectomy—a procedure to remove a small portion of disc pinching a nerve
- Facetectomy—a surgery that removes a portion of the spinal joint to decompress a nerve compressed by a bone spur
- Foraminotomy—a procedure to relieve pressure on compressed nerves by enlarging the space between the vertebrae where the nerve exits the spinal column.
- Laminectomy—a procedure to remove all or part of the posterior portion of the vertebral bone, relieving pressure on the nerves and/or spinal cord.
As with any surgery, spine surgery comes with benefits and risks. And many patients may take weeks or months to decide if surgery is right for them. Dr. Seal says that is perfectly fine. Patients need to take the time to make choices that are best for them.
“They'll often ask what to do, and I'll usually say – I don't live your life every day, and I don't know how much pain you're in. Pain is too subjective," Dr. Seal says. “So, I ask will you be regretful that you didn't pursue other things before pursuing surgery, or will you be at peace with it as much as you can be."
“The decision is always the patient's," Dr. Seal says. “We just give them options, and surgery in some instances is an option."
If you are experiencing chronic back pain and would like to see a specialist with The Christ Hospital Physicians – Spine Surgery, you can schedule an appointment online or call 513-557-4900.