Q: I have lower back pain and my doctor thinks I have degenerative disc disease. What is that?
A: Spinal discs are flexible, compressible cushions between the bones of the spine. The discs act as shock absorbers for the spine and allow the spine to bend and twist. As we live life, we put pressure on the discs, and this helps squeeze nutrients into the discs.
With age or excessive pressure on the discs, the discs can get dryer, thinner and stiffer. This is “degenerative disc disease” – the gradual aging and wearing of the discs. It is not really a disease any more than getting wrinkles on the forehead or smile lines around the eyes is a disease. eople who smoke, are overweight, or do a lot of heavy physical work are at a higher risk for degenerative disc disease.
As the discs thin, they provide less cushioning, and the bones on either side of the disc begin to feel more pressure. The bones respond by becoming tougher – similar to how a foot becomes calloused over areas of extra pressure - and the bone grows larger to spread the pressure out over a larger area.
The aging of our discs is one factor responsible for the gradual loss of height seen in the elderly. If each of the 23 discs in our spine loses just 1 mm in height, the spine will be almost 1 inch shorter.
Degenerative disc disease usually occurs in the neck (cervical) or low back (lumbar) regions, as these are the areas of the spine that move the most; the middle back moves less because of the rigidity of the ribs, and as a result there is typically less wear of the discs in the middle back (thoracic) region.
Degenerative disc disease does not make the spine fragile; in fact, because of their bony calluses, the bones of someone with degenerative disc disease are often stronger than the average spine. However, pain from degenerated discs can make activity painful and make the spine feel weak.
Most people with degenerative discs can control their pain with aerobic exercises such as walking, swimming, using an elliptical machine, or AirDyne bicycle (a stationary bicycle with moving handlebars).
Medications such as acetaminophen (Tylenol) can help. Antiinflammatory medications such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can help, but long term use might cause irritation of the kidneys, liver, or stomach. If you choose to take these on a long-term basis, ask your doctor about prescription anti-inflammatory medications that may have fewer risks.
Physical therapy can help teach you to strengthen your “core” muscles so that there is less twisting and irritation of the discs, and therefore less pain. Chiropractic manipulation can help stop an acute attack of muscle spasm from disc degeneration.
In severe cases where disc pain is significantly limiting daily activities, a surgeon can remove the degenerated disc and replace it with a metal spacer, a surgery called “spinal fusion.” This may put extra stress on the discs above and below the metal spacer, however, so the best candidates are people with only one or two worn discs.
A spine specialist can help you determine the best course of treatment.
By John Revord, MD, physiatrist (non-surgical spine specialist), NeuroSpine Center of Wisconsin.