Spine wears down with time
Q: I’ve been struggling with back stiffness and pain for a long time, but it has gotten worse in the past few years. My doctor told me I have degenerative disk disease. What does that mean? What can I do to feel better? A:
Degenerative disk disease is a common cause of back pain. Our spinal disks wear out with age and use. About 20% of all U.S. adults have some amount of degeneration by age 65. This increases to about 35% by age 80. Everyone has some degeneration with time. It may or may not worsen or cause symptoms.
Disks are the fluid-filled cushions between the bones in your spine. The disk is flexible, and it fills the space between the vertebrae and provides cushion to allow the spine to bend and flex without pain. Like airbags in a car, the disks prevent the vertebrae from hitting each other and act as shock absorbers.
Degenerative disk disease is the result of multiple factors. Age and time increase the odds of developing the disease. Women are more likely than men to develop the condition. Carrying excess body weight increases your risk, as well as spine strain from manual labor, poor posture or heavy lifting.
As the disease develops, spinal disks start to lose fluidity. They become dehydrated and stiffen. This leads to the disks shrinking and losing height. Often, disks in the low spine degenerate first.
As degeneration progresses further, the disks dry out more and may push on nerves. A person may develop a ruptured or bulging disk. Often, people have a bulging or ruptured disk with no symptoms, but sometimes this can cause symptoms in one or both legs.
A bulging disk occurs when the outer layer of the disk, the annulus fibrosis, bulges into the spinal canal. A ruptured disk, also called a herniated or slipped disk, happens when the inner part of the disk, the nucleus pulposus, leaks out of the disk through a crack in the annulus fibrosis.
If a disk continues to degrade, it can result in complete loss of the disk. Then the patient has only an air-filled space between the vertebrae, or the bones of two vertebral bodies directly touch. If your condition progresses this far, you likely will have severe pain, significant stiffness and possibly nerve compression.
There are many treatments options. Nonsurgical treatments are important throughout the continuum. Weight loss can be beneficial, along with decreasing manual labor. Injections, medications, physical therapy and strengthening your core can ease symptoms.
Surgery is only an option after nonsurgical treatments are exhausted. Surgery is considered if the condition is causing nerve compression and worsens despite physical therapy, medications and injections. Symptoms from nerve compression include pain, numbness or weakness that radiates into a limb. The following are three surgical options for the disease.
Decompression surgery, such as a laminectomy or diskectomy, creates space for the compressed nerves by removing part of the vertebrae bone or damaged part of the disk. Relieving pressure on the spinal cord or nerves can ease symptoms.
Stabilization surgery, such as a spinal fusion, improves stability by connecting two or more vertebrae in the spine.
Disk replacement surgery replaces a wornout disk with an artificial one. Replacing a disk may relieve pain in your arms or legs while maintaining flexibility.
Ask your provider about your back pain and possible treatments for degenerative disk disease.