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Spondylopathy / Spondylosis / Degenerative Disc Disease

Degenerative disc disease is one of the most common causes of low back pain and neck pain, and also one of the most misunderstood For most people the term "degenerative" understandably implies that the symptoms will get worse with age. However, the term does not apply to the symptoms, but rather describes the process of the disc degenerating over time.

While it is true that the disc degeneration is likely to progress over time, the pain from degenerative disc disease usually does not get worse and in fact usually gets better given enough time. The degenerative cascade theory explains how this process works.

What is Cervical Degenerative Disc Disease?

Cervical disc degeneration is a common cause of neck pain, most frequently felt as a stiff neck. Cervical degenerative disc disease is much less common than disc degeneration in the lumbar spine because the neck generally is subjected to far less torque and force. Nonetheless, a fall or a twisting injury to the disc space can spur degeneration, and accumulated wear and tear on the disc over time can also lead to neck pain caused by disc degeneration. In addition to having the low-grade pain of a stiff or inflexible neck, many patients with cervical disc degeneration have numbness, tingling, or even weakness in the neck, arms, or shoulders as a result of nerves in the cervical area becoming irritated or pinched. For example, a pinched nerve root in the C6-C7 segment could result in weakness in the triceps and forearms, wrist drop and altered sensation in the middle fingers or fingertips. Cervical disc degeneration can also contribute to spinal stenosis (more specifically, the development of cervical stenosis) and other progressive conditions, as well as a more sudden disc herniation. Conservative care (non-surgical) is recommended as the primary strategy and surgery is only considered if a concerted effort at conservative care fails to provide adequate pain relief or a patient's daily activity has been significantly compromised. However, patients should know that surgery for neck pain is much less reliable than surgery to relieve arm pain from cervical degenerative disc disease.

What is LumbarDegenerative Disc Disease (DDD)?

Degenerative disc disease in the lumbar spine, or lower back, refers to a syndrome in which a compromised disc causes low back pain.Although there is a slight genetic component to individuals who suffer from DDD, the true cause is probably multifactorial. It could be from simple wear and tear, or may have a traumatic cause. However, it rarely starts from a major trauma such as a car accident. It is most likely due to a low energy injury to the disc that progresses with time. The disc itself does not have a blood supply, so if it sustains an injury it cannot repair itself the way other tissues in the body can. An otherwise insignificant injury to the disc can start a degenerative cascade whereby the disc wears out. Despite its rather dramatic label, degenerative disc disease (DDD) is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, after a patient reaches 60, some level of disc degeneration is a normal finding on an MRI scan, rather than the exception.

Lumbar DDD Causes

The low back pain associated with lumbar degenerative disc disease is usually generated from one or both of two sources:

Inflammation, as the proteins in the disc space irritate the surrounding nerves - both the small nerve within the disc space and potentially the larger nerves that go to the legs

Abnormal micro-motion instability, when the outer rings of the disc, called the annulus fibrosus, are worn down and cannot absorb stress on the spine effectively, resulting in movement along the vertebral segment.Excessive micro-motion, combined with the inflammatory proteins, can produce ongoing low back pain. Fortunately, over a long period of time the pain from lumbar degenerative disc disease eventually decreases, rather than becoming progressively worse. This is because a fully degenerated disc no longer has any inflammatory proteins (that can cause pain) and usually collapses into a stable position, eliminating the micro-motion that generates the pain.Because of this process, even patients who experience severe pain and frequent flare-ups in their 40's may find that their back pain is almost gone when they are in their 60's. Although back pain from osteoarthritis is common in our later years, it is not often from the disc space itself.

Manual Therapy

Spinal manipulation, such as chiropractic manipulation, can relieve low back pain through several means, including taking pressure off sensitive nerves or tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and - as with more active exercise - promoting the release of endorphins within the body to act as natural painkillers.For the vast majority of people with symptomatic lumbar degenerative disc disease, a combination of nonsurgical treatments as provided at Capri Spine Clinic suffices to provide enough pain relief and ability to enjoy everyday activities.