Degenerative disc disease happens due to aging when one or more discs located in between the vertebrae of the spinal column break down or worsen progressively leading to pain. It might also lead to numbness, weakness, and pain that spreads down the leg.
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Anatomy of Intervertebral Disc
Intervertebral discs are also referred to as intervertebral fibrocartilage or spinal discs. Their function is to provide padding between the vertebrae of the spine. Their structure is elastic and they are made of fibrocartilage tissue.
What is Annulus Fibrous?
Annulus fibrosus is the outer part of the disc. Being fibrous and tough it has several layers that are overlapping. They have the nerve and vascular supply with pain-sensitive fibers. When it breaks or develops cracks it causes pain in the lower back region
What is Nucleus pulposus?
It is soft and gelatinous and is the inner core of the disc. It is an avascular structure and also it doesn’t have a nerve supply.
The function of intervertebral discs:
When the spine moves or bears weight the function of the intervertebral discs is to cushion the stress. They help the spine while bending. In the aging process, there is repeated stress on the spine on a daily basis and occasional injuries that include minor or unnoticed ones. These injuries can damage the discs in the back.
Changes include :
- Loss of fluid : The intervertebral discs of a healthy young adult consist of up to 90 percent fluid. The fluid content tends to decrease due to aging as the disc becomes thinner. The distance between the vertebrae starts becoming smaller. Its function as a cushion and shock-absorber becomes less effective.
- Disc structure : Very small tears or cracks develop in the outer layer of the disc. There is a soft, gelatinous material in the inner part that may seep through the cracks or tears. This will rupture or bulge the disc. In a worst-case scenario, the disc may break into fragments.
- The spine becomes less stable when the vertebrae is left with less of padding between them. As a means to compensate the body tends to build osteophytes or bone spurs. These bone spurs are small bony projections developing along the edges of the bones.
- These projects can press the spinal cord or spinal nerve roots. They can cause pain and undermine nerve function.
Other problems include :
- a breakdown of cartilage, the tissue that cushions the joints
- a bulging disc, known as a herniated disc
- a narrowing of the spinal canal, or spinal stenosis
These changes and problems affect the nerve and lead to weakness, numbness, and pain.
Risk Factors :
The biggest risk factor is age though there are other factors that can speed up the process of degeneration.
These include :
- Obesity,
- strenuous physical work,
- tobacco smoking,
- an acute or sudden injury, such as a fall.
When there is a major or minor injury it leads to sudden or unexpected pain in the back. This is how the degenerative disc pain begins. Also, it can manifest as a slight or minor back pain that worsens over a period of time.
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Symptoms :
- There can be no symptoms of disc degeneration. Alternatively, the pain might be so intense that one might not be able to continue with daily activities.
- Infact, this condition begins with damage to the spine. But as time passes by other parts of the body might get affected. Often symptoms worsen with age.
- The feeling of discomfort can range from mild to severe and debilitating. This can then result in osteoarthritis, accompanied by stiffness in the back and pain too.
- One of the most common and early symptoms is pain and weakness in the back that shows in another area.
- In case of damage in the lower back or lumbar spine, the discomfort might manifest in the upper thighs or buttocks. A tingling feeling, numbness or both can be experienced in the feet or legs.
- In case there is damage in the neck area or cervical spine, the pain spreads to the arms, hands, and shoulders.
- At times there can be instability in the spine. This can lead to muscle spasms in the lower neck or back since the body attempts to stabilize the vertebrae. This can get extremely painful.
- Intense pain can flare-up.
- The pain can worsen while sitting, lifting, twisting, or bending. It might provide relief to the patient when he/she walks, lies down, or changes position.
Diagnosis
The doctor will ask about symptoms, when and where the pain occurs, whether there is tingling or numbness, and which situations cause the most pain? They will also ask about any injury, accident or falls.
A physical examination may assess for:
- Muscle strength: The doctor may check for atrophy, wasting, or abnormal movements.
- Pain with motion or in response to touch: The patient will be asked to move in specific ways. There is a possibility of degenerative disc when pressure applied to the lower back causes pain.
- Nerve function: The physician taps different areas with a reflex hammer.
- The nerve root can be compressed when there is poor or no reaction.
- Hot and cold stimuli may be used to see how well the nerves react to temperature changes.
Your doctor might ask you to get the following diagnostic tests :
- Imaging scans, such as CT or MRI, to gather information about the state of the spinal nerves, the discs, and how they are aligned.
- A discogram, which involves injecting a dye into the soft center of the disc, or several discs. This aims at observing if there is a pain in the disc.
- The dye will show up in the CT scan or X-ray. The use of a discogram may be controversial. Though herniated discs do not always lead to symptoms.
- The doctor can also test for other conditions like a tumor or different kinds of damage to make sure about the diagnosis.
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