Degenerative Disc Disease

About 60 to 80% of people will have a bout of low back pain at sometime in their lives[1

,2]. Like other joints in the body the vertebrae and the discs of the low back can undergo arthritic changes. These "degenerative" changes can result in alterations in the shapes of these structures including bulging discs which can impinge on the nerves which run through these structures on their way to the extremities. This can create inflammation, swelling, and sensitivity.[3,4] Scientific investigation has also shown that the discs themselves, like other body parts also contain nerves[5,6]and can generate pain when they are irritated.[8,7]

Given the amount of wear and tear that we go through its surprising that it has been shown that the majority of individuals with degenerative disc disease (DDD) do not have any pain.[9,10] Doctors today view the presence of disc degeneration and the presence or absence of low-back pain a little like the occurrence of gallstones and abdominal pain. Although most people with gallstones show no symptoms, if a patient has gallstones and pain, those symptoms may be attributed to the gallstones.

Although low-back pain results in significant disability, 95% of these patients return to their previous employment within 3 months of the onset of symptoms.[6] Numerous studies have shown that lumbar disc herniations will subside over time in the majority of cases without surgery.[11,12,13,14] Degenerative disc disease is usually treated successfully without surgery.[15] Medical treatments can include an injection of steroid medication into the space around the nerve root. Physiotherapy may include transcutaneous electrical nerve stimulation, acupuncture, exercises, or physical therapy modalities to help relieve pain.

Although DDD is common in individuals without symptoms, large lesions that compress nerves are uncommon. Signs that the nerves are affected may include loss of bowel or bladder control, progressive loss of strength in the legs, and severe intractable pain. These are sometimes indications that surgery may be required, although patients without these symptoms who get surgery may also obtain superior outcomes with surgery.[16] In addition, orthopaedic post surgical recovery rehabilitation is recommended in some cases for a more complete recovery. Long-term improvement of symptoms may occur with or without resolution of the herniated disc.

by: Brian Anderson

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