Lumbar (low back) degenerative disc disease (DDD) is a common condition in aging adults. The intervertebral discs serve as the spine’s shock absorbers and, as we age, discs gradually dry out, losing strength and resiliency. In most people, these changes are gradual. In fact, many older patients do not know they have degenerative disc disease until it is diagnosed when they see a physician for a check-up or treatment of some other problem.
Symptoms
Disc degeneration is a normal part of aging, and usually is not a problem. However, DDD can cause discs to lose height and become stiff. When disc height is lost, nerve impingement, bone and joint inflammation, and resultant pain can occur. Disc degeneration causes loss of the joint space, similar to arthritis pain and inflammation. In severe cases, pain may be constant.
Diagnosis
Lumbar DDD must be diagnosed by an expert physician. This typically involves the following steps.
- Medical history. The doctor will inquire about symptoms, their severity, and treatments you have already tried and the results.
- Physical examination. The physician will examine you for limitations of movement, balance problems, and pain. The physician will test your reflexes at the extremities and evaluate muscle weakness, loss of sensation, and signs of neurological injury.
- Diagnostic tests. Many times x-rays help to rule out other problems such a tumor or infection. X-rays may also reveal loss of disc space between the vertebrae. In some cases, a test called discography confirms the diagnosis. Discography involves injecting contrast dye into the affected disc (or discs) to create a clearer image and temporarily replicate symptoms.
Nonoperative Treatment
Most cases of lumbar degenerative disc disease do not require surgery. Many different nonsurgical treatments help relieve symptoms. These include:
- Medications, such as an anti-inflammatory to reduce swelling and pain, muscle relaxants to calm spasm, and occasionally narcotic painkillers to alleviate acute pain.
- Cold/heat therapy, especially during the first 24 to 48 hours.
- Spinal injections (i.e. epidural) may help relieve low back and leg pain.
- Physical therapy, which may include gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
- Chiropractic or alternative therapy (i.e. acupuncture).
As part of physical therapy, patients are also instructed in proper posture and body mechanics to enhance healing and prevent further injury.
Surgical Treatment
If symptoms of lumbar DDD persist despite nonoperative treatments, further diagnostic tests may be necessary. Tests may include a CT scan, MRI, myelogram, and discography. If one or more intervertebral discs are damaged, causing pain or other symptoms (e.g. weakness in muscles), surgery may be necessary. The surgical procedure likely will include a discectomy (removal of the damaged disc) and interbody fusion (fusing together the vertebrae above and below the disc space).
Many procedures are performed using minimally invasive techniques, which can help speed your recovery. The surgeon will discuss the risks and benefits of various surgical options with prospective patients.
Conclusion
While lumbar DDD is a natural part of aging, it does not mean that low back pain is a natural part of life. Much is known about this condition and there are many effective treatment options. Some patients may be candidates for surgery, which should be undertaken only with a thorough understanding of the potential risks and benefits of an operation.