FAQ’s on Degenerative Disc Disease Treatment in Philadelphia

Degenerative disc disease (DDD) is an age-related condition that occurs from repeated daily stresses on the spine and gradual breakdown of the intervertebral discs. Pain of the disc is called discogenic pain.

What are intervertebral discs?

Discs are spongy fibrocartilage padding between each vertebra of the spine. The outer portion is called the annulus fibrosus, and it is fibrous, tough, and composed of numerous layers. The inner core is called the nucleus pulposus, and it is gel-like and soft. For healthy adults, the inner portion contains around 90% water.

What are the signs and symptoms of degenerative disc disease?

One symptom of degenerative disc disease is pain. However, some people with this condition do not have symptoms. The pain associated with DDD often radiates to the buttocks and upper thighs. In addition, tingling and numbness of the leg and foot are common.

What causes DDD?

As the body ages, and from wear-and-tear and disc break down, the discs lose fluid, which makes them thinner. This causes the distance between each vertebra to become smaller. When tears or cracks develop in the disc’s outer layer, the soft, gel-like material leaks out. In addition, sudden injury from a fall can accelerate the degeneration process.

How common is degenerative disc disease?

In a study involving almost 1,000 participants with the mean age of 66.5, the prevalence rate of DDD was 77% for women and 71% for men who where under 50 years of age. For those older than 50 years, that rate was 90%.

How is degenerative disc disease diagnosed?

To diagnose DDD, the doctor will first ask the patient about his/her symptoms and what activities cause the most pain. In addition, the doctor will take a medical history and conduct a physical examination, which involves checking nerve function and muscle strength. Diagnostic tests are ordered, such as computerized tomography (CT) scans and magnetic resonance imaging (MRI) scans. A discogram involves dye being injected into the center of the disc to assess for cracks in the outer layer.

How is DDD treated?

The treatment of degenerative disc disease depends on the patient’s condition, the extent of the injury, and the severity of the disease. Options include:

  • Medications – Taking nonsteroidal anti-inflammatory drugs (NSAIDs) will help with the inflammation and pain. Examples include naproxen, ibuprofen, and ketoprofen. For severe pain, narcotic analgesics are used short-term.
  • Physical therapy – Therapy is designed to improve spine range of motion, improve strength, and control pain. The therapist and doctor work together to develop a rehabilitation program tailored to the patient’s individual need.
  • Intradiscal injection – The pain specialist will inject a corticosteroid into the affected disc using x-ray guidance. A recent clinical study found this procedure to be safe and effective for treatment of back pain related to DDD.
  • Epidural steroid injection (ESI) – To alleviate irritation to the nerve root near the affected disc, the doctor injects a corticosteroid (with or without a long-acting anesthetic) into the epidural space. Based on research reports, ESI is 90% effective.
  • Disc regenerative therapy – To stimulate new collagen growth and improve disc strength, the doctor may inject the disc with a glucosamine and dextrose solution. A recent clinical study found that this procedure alleviated discogenic pain.
  • Intradiscal electrothermal annuloplasty (IDET) – With this procedure, the affected discs are heated using CT discography. This hardens the disc and makes it resistant to weight-bearing movements. Based on clinical studies, this procedure has an efficacy rate of around 70%.

Resources

Abdi, S, Datta, S, Trescot, AM et al. (2007). Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician, 10(1), 185-212.

Cao, P, Jiang L, Zhuang C, Yang Y, et al. (2011). Intradiscal injection therapy for degenerative chronic discogenic low back pain with end plate Modic changes. Spine Journal, 11(2), 100-106. doi: 10.1016/j.spinee.2010.07.001

Muzin S, Issac Z, & Walker J (2008).The role of intradiscal steroids in the treatment of discogenic low back pain. Curr Rev Musculoskelet Med, 1(2), 103-107. doi:  10.1007/s12178-007-9015-y

Teraguchi, M., Yoshimura, N., Hashizume, H. et al. (2014). Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study. Osteoarthritis and Cartilage, 22(1), 104-110.