Degenerative Disc Disease (Arthritis) Can be Helped
What is DDD?
Degenerative disc disease is a condition involving damage to spinal discs that often causes lower back pain. The spinal discs are located between the vertebrae and are made up of layers that act as shock absorbers. The outer layer, the annulus fibrosus, is very firm, while the inner layer, the nucleus pulposus, is made up of softer, gelatinous material and is marble-like. It is not technically a disease, but rather a state of disc dehydration and deterioration The condition is called degenerative because the spinal discs do not have the capability to heal back to normal after they have been damaged.
DDD can occur due to a combination of cumulative trauma, poor dietary and exercise habits and the aging process. While DDD can occur with age, and most will experience some form of this condition, some people will not have any symptoms. In other words, the severity of the degeneration is not always correlated to the degree of pain or dysfunction.DDD occurs in three phases: Phase I - tears around the outer wall of the disc (annulus fibrosus) Phase II - the joint progressively losing strength leading to instability
Phase III - results in loss of disc height, disc space narrowing, moderate to severe endplate damage, disc fibrosis and the formation of osteophytes which ultimately leads to the surrounding vertebrae to fusing together, as the body attempts to regain stability.
What are the symptoms of a DDD?
The symptoms of DDD can be very varied, but will usually have at least one or more of the following:
- Lower Back Pain – usually worse when sitting for extended periods of time, or when performing bending, lifting or twisting movements. Changing positions frequently usually helps the pain, and lying down is often the most comfortable position. Often described as achy, but can be sharp if the boney surfaces come too close together.
- Neck Pain – limitation of extension (looking up), and rotation are common. The first sign may be difficulty in turning the head to see what is behind you when driving.
- Leg/Arm Pain – can be nerve compression or joint referral
- Pins/Needles/Numbness – in the leg/arm and/or feet/toes/hand/fingers indicates nerve compression
What are the testing procedures to diagnosis a herniated disc
- History and Examination – this is often the most neglected, yet, by far the most important part of the diagnosis process. Quoting Sir William Osler MD, "Listen to your patients, they are telling you the diagnosis”. It is absolutely crucial to spend the time taking a detailed history.” You cannot find what you do not look for”. It is absolutely crucial to spend the time performing a detailed exam. Based upon the results, a determination will be made as to whether to begin treatment or to order further tests.
- X-Rays – used to check for bone health, degenerative changes and structural alignment.
- Cat Scan(CT) – can be used to see a bony changes and stenosis. While less expensive than an MRI, it will expose the patient to high levels of radiation. Generally not the test of choice.
- MRI - this is the gold standard test to see DDD. It will clearly show the entire disc and all the boney/soft tissue changes. There are inherent problems; First is the cost, which can be as high $2000 Second, is that the time to perform the test is about 30-45 minutes and you must lie still. This may be very difficult for many patients. Third and most importantly, is that most often, the findings that the MRI shows may have nothing to do with the presenting condition. Studies have shown that many asymptomatic people, who have never had any back pain, will have DDD MRI findings. This does pose a diagnostic dilemma and is why you have to “marry the patient to the MRI, not the MRI to the patient”. Again, the history and examination will determine treatment going forward, in spite of the MRI findings
What treatment can be done to help DDD?
While there are certainly many different types of treatment, that are effective for degenerative disc disease, many of which we readily use in our office, namely spinal manipulation, electric muscle stimulation, ultrasound and spinal exercises, it is not the intent of this article to list all of them but simply to introduce you to a type of treatment that you may not be aware of. SDT is not meant to necessarily replace any of the above therapies. In fact, utilizing them can be very helpful and will often enhance recovery. As a stand alone therapy or as an adjunct to pre-existing therapies, STD can be extremely effective to help you get well.
Spinal Decompression Therapy
Spinal Decompression Therapy is FDA approved and has a very high success rate for pain associated with herniated discs, degenerative disc disease and spinal stenosis.… even after failed surgery. It is a non-surgical, traction based therapy for the relief of back/ leg pain or neck/arm pain. During this procedure, we have the ability to cycle through distraction and relaxation phases and by proper positioning, a spinal disc can be isolated and placed under negative pressure, causing a vacuum effect within it, drawing it back from its herniated position and away from the nerve. If your condition is not discal and is secondary to arthritis, which can lead to spinal stenosis, we can change the parameters to focus on a more continuous shorter hold/relax phases, creating a “milking of the joints”. This will help to reduce inflammation and allow diffusion (absorption) of nutrients into the arthritic areas to lubricate and heal the irritated structures.