CNY Orthopedic Sports Medicine, PC: InjuryDetail: Degenerative Disc Disease
 
Injuries and Conditions: Back & Spine: Degenerative Disc Disease: Medical Details
 
Overview
The anatomy of the spine is divided into three major regions. These regions are made up of bones known as vertebrae. Each vertebra within the spine is given a letter and number label that describes its exact location. The neck, or cervical spine, is designated by the letter "C" and contains seven vertebrae, numbered 1 through 7. The upper and mid-back represents the thoracic spine and each of the twelve vertebrae (numbered 1 through 12) are given the prefix of the letter "T".

The lower back, or lumbar spine, has five vertebrae identified with the number "L" and the numbers 1 through 5. For example, L4 means that the area of the spine being evaluated is the lumbar spine at vertebrae number 4. The sacrum, lowest level of the spine, contains vertebrae that have grown (fused) together and are usually referred to as one single structure.

The vertebrae of the cervical, thoracic, and lumbar spine are separated from each other by soft oval shaped cushions known as intervertebral discs. These discs are made up of a tough fibrous outer ring called the annulus fibrosis. These discs function in a similar manner to the shock absorber of a car and allow the spine to bend, flex, and twist while decreasing or dampening the force and stress that these movements place on the spine. The sacral spine does not contain intervertebral discs.

Three major regions of the spine:

  • Cervical spine (neck)
  • Thoracic spine (mid-back)
  • Lumbar spine (low back)

    Structures involved in a disc herniation:

  • Intervertebral Discs: pads of tissue between the vertebrae
  • Facet Joints: joints which connect the back of the vertebrae to each other
  • Ligaments: elastic bands that support and connect the vertebrae
  • Lamina: Arches of bone that form the roof of the spinal canal
  • Pedicles: Bones that form the walls or the sides of the spinal canal
  • Spinal Cord / Nerve Roots: major electrical pathways of the Central Nervous System (CNS)
  • Spinal Canal: A tunnel of bone through which the nerve root and spinal cord pass.

    The intervertebral discs, located between each vertebrae function as shock absorbers and allow the spine to twist and bend and tolerate significant axial loads. Since motion occurs in this area, discs can be thought of as a special type of joint that allows only minimal movement between the vertebrae.

    As a natural phenomenon of the aging process, discs lose their water content and degenerate. Consequently, tears can occur in the outer portion or peripheral ring of the disc. In adults, the annulus has nerve fibers while the center of a disc does not. A tear in this outer annulus can be quite painful. Although these degenerative processes are part of the natural aging of the spine, the discs of some people degenerate much more quickly than in others.

  • Causes of Injury
  • Degenerative changes associated with the aging process, result in the lose of water content and weakening of the disc. This weakening can cause the outer layer of the disc (the annulus fibrosus) to tear and allow for the extrusion of or herniation of the softer, central portion of the disc. A tear in the outer annulus fibrosus or supporting ligaments can be very painful.
  • Occupational activities can place a high level of pressure on the spine over an extended period of time. These activities may involve repetitive lifting of heavy objects, repetitive activities while standing (assembly line work), and use of machinery that vibrates.
  • Activities which repetitively place stress on the back includes sports such as soccer, golf, and tennis.
  • Traumatic injury to the spine that results in the development of post-traumatic arthritis.
  • Pre-existing conditions/ diseases of the spine which pre-dispose the spine to degenerative changes.

  • Diagnosis
    The signs and symptoms of degenerative disc disease can also mimic other spinal disorders. Included in this differential diagnosis are the conditions of a herniated disc, or spinal stenosis, spondylosis or spondylolisthesis.

    To confirm the diagnosis of degenerative disc disease, a complete history and physical exam performed by an orthopedic surgeon is recommended.. The physical exam will include tests that measure reflex response, motor, and sensory function. The physical exam findings may strongly indicate degenerative disc disease, but to make an accurate diagnosis, radiographic imaging studies may also be ordered.

    Radiographic imaging studies include:

  • Plain x-ray films of the spine
  • Magnetic Radiographic Imaging (MRI)
  • CT Scan/Mylogram
  • CT Scan/Discogram

    If degenerative disc disease is diagnosed, an orthopedic surgeon will review recommended treatment options to determine the best treatment option for each individual with the condition.

  • Anatomy
     


     Product Considerations
    NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


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