Degenerative Disc Disease

Full Description


etween each pair of bony vertebral bodies is a soft disc that acts as a shock absorber. The disc is made up of two parts, the annulus and the nucleus. The annulus is the outer part of the disc and is made of many rings of cartilage-like tissue. The nucleus, a jelly-like substance, is at the center of the disc. As we age, the disc can dehydrate, making it less supportive and more prone to injury. The disc height decreases as the disc dehydrates and can produce chemicals locally that irritate the surrounding tissue, causing neck or back pain. There may also be pain in the arms or legs. Disc degeneration is very common in the older population, but also occurs in younger adults. Factors contributing to disc degeneration are not fully understood, but there appears to be a genetic link. It is unclear how much activity “wear and tear,” such as with repetitive bending/lifting, truly affects disc degeneration. Almost everyone’s discs dehydrate and degenerate with age. In many people, degeneration is not painful. Sometimes the process is painful. Acute disc pain may also occur after a tear or injury to the disc tissue.

Screening and Diagnosis


he diagnosis of painful disc degeneration begins with the doctor reviewing your history and performing a physical examination. X-rays may be made to investigate reduced disc height or other problems. An MRI scan may be obtained as it helps assess water content of the discs and any resultant “bulging” or protruding of the disc tissue. However, because disc degeneration is so common, many people have discs that look abnormal on an MRI, although they may not have back or neck pain. Because of this problem, other diagnostic tests, such as discography, may be done to verify if the disc is causing pain. Sometimes other injections are also done to rule out other possible pain origins.

Treatments for Degenerative Disc Disease


ypically, the first line of treatment includes active physical therapy and education. Strengthening of the muscles in the trunk and around the spine may help to reduce pain. Medication may be prescribed. If an unacceptable level of pain persists for several months after other treatments, surgical options may be considered. There are several minimally invasive procedures that are most frequently used for early stages of disc degeneration. Various interbody fusion procedures may be used in which disc tissue is removed and replaced with bone to stabilize the painful spinal segment. Total disc replacement or artificial discs may be used as well. The disc tissue is removed and a mobile disc prosthesis is put into the disc space. It is important to discuss treatment options with your doctor in deciding which treatment, if any, may be best for you.