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07/19/2009 10:56 AM

Disc Degenerative Disease

hatbox121
hatbox121  
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Degenerative disc disease

From Wikipedia, the free encyclopedia

Degeneration of the intervertebral disc, often called "degenerative disc disease" (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one's life. While disc degeneration is a normal part of aging and for most people is not a problem, for certain individuals a degenerated disc can cause severe constant chronic pain.

[edit] Causes

Trauma, such as a simple lifting accident, is the most common cause of disc degeneration. After trauma, the discs in the spine dehydrate and lose their ability to act as shock absorbers between the vertebrae. There is minimal blood supply to the discs, so they lack the ability to heal or repair themselves. Sometimes referred to as 'disability gold' or the ability to claim disability payments with no medical investigation.

[edit] Symptoms

With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting. Chronic neck pain can also be caused in the upper spine, with pain radiating to the shoulders, arms and hands.

[edit] Understanding disc pain

After an injury, some discs become painful because of inflammation. Some people have nerve endings that penetrate more deeply into the annulus fibrosus (outer layer of the disc) than others, making discs more susceptible to becoming a source of pain. The scientific community[who?] has the opinion that the healing process involved in the repair of trauma to the outer annulous results in the innervation of the resultant scar tissue, and subsequent pain in the disc, as these nerves become inflamed by nucleus pulposus material. Degenerative disc disease can lead to a chronic debilitating condition and can have a serious negative impact on a person's quality of life. When pain from degenerative disc disease is severe, traditional nonoperative treatment is often ineffective.

[edit] Treatment options

Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, chiropractic manipulative therapy (CMT), osteopathic manipulation, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs, chiropractic treatments, traction, or spinal injections often provide adequate relief of these troubling symptoms.

Surgery may be recommended if the conservative treatment options do not provide relief within two to three months. If leg or back pain limits normal activity, if there is weakness or numbness in the legs, if it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary, most often spinal fusion. There are many surgical options for the treatment of degenerative disc disease. The most common surgical treatments include:[1]

Intervertebral disc annuloplasty (IDET): A procedure wherein the disc is heated to 90°C for 15 minutes in an effort to seal the disc and perhaps deaden nerves irritated by the degeneration.

Anterior cervical discectomy and fusion: A procedure that reaches the cervical spine (neck) through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone or other graft substitute, and in time, that will fuse the vertebrae.

Cervical corpectomy: A procedure that removes a portion of the vertebra and adjacent intervertebral discs to allow for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.

Facetectomy: A procedure that removes a part of the facet to increase the space.

Foraminotomy: A procedure that enlarges the vertebral foramen to increase the size of the nerve pathway. This surgery can be done alone or with a laminotomy.

Laminoplasty: A procedure that reaches the cervical spine from the back of the neck. The spinal canal is then reconstructed to make more room for the spinal cord.

Laminotomy: A procedure that removes only a small portion of the lamina to relieve pressure on the nerve roots.

Micro-discectomy: A procedure that removes a disc through a very small incision using a microscope.

Percutaneous disc decompression: A procedure that reduces or eliminates a small portion of the bulging disc through a needle inserted into the disc, minimally invasive.

Spinal decompression: A non-invasive procedure that enlarges the Intra Vertebral Foramen (IVF) by aiding in the rehydration of the spinal discs.

Spinal laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

New treatments are emerging that are still in the beginning clinical trial phases. Glucosamine injections are thought to offer some pain relief for degenerative discs at best, and at worst, do nothing while also not affecting more aggressive treatment options. Artificial disc replacement is viewed cautiously as a possible alternative to fusion in carefully selected patients. Adult stem cell therapies for disc regeneration are in their infancy. Investigation into mesenchymal stem cell therapy knife-less fusion of vertebrae in the United States began in 2006.[2]

http://en.wikipedia.org/wiki/Degenerative_disc_disease

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07/19/2009 10:58 AM
hatbox121
hatbox121  
Posts: 11098
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Introduction

The process of degeneration of the intervertebral discs causes many problems in the spine. Everything you do during the day while being upright tests the spine's ability to support your body weight. Minor injuries to the disc may occur and not cause pain at the time of the injury. These repeated daily stresses and minor injuries can add up over time and begin to affect the discs in your spine. The disc eventually begins to suffer from the wear and tear-it begins to degenerate.

Learn about degenerative disc disease including

what parts of the spine are affected

what causes the condition

what symptoms are present

what treatment options are available

Anatomy

In order to understand your symptoms and treatment options, it helps to begin with a basic understanding of your low back. This includes becoming familiar with the various parts that make up the lumbar spine and how these parts work together.

Learn more about the anatomy of the lumbar spine.

The main problem with degenerative disc disease lies within one or more of the intervertebral discs. There is a disc between each vertebra in the spine. Much of the mechanical stress of everyday movements is transferred to the discs. The intervertebral discs are designed to absorb pressure and keep the spine flexible by acting as cushions during body movement-similar to shock absorbers. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses or provide the movement needed to bend and twist.

shock absorbers. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses or provide the movement needed to bend and twist.

Causes

A healthy intervertebral disc has a great deal of water in the nucleus pulposus (the center portion of the disc). The water content gives the nucleus a spongy quality and allows it to absorb spinal stress. Excessive pressure or injuries to the disc can cause the injury to the annulus (the outer ring of tough ligament material) that holds the vertebrae together. The annulus is generally the first portion of the disc to be injured. Small tears show up in the ligament material of the annulus. These tears heal by scar tissue, which is not as strong as normal ligament tissue. The annulus becomes weaker over time as more scar tissue forms. This can lead to damage of the nucleus pulposus. It begins to lose its water content and dry up. View animation of degeneration.

Loss of water content causes the discs to lose some of their ability to act as cushions. This can lead to even more stress on the annulus and still more tears as the cycle repeats itself. As the nucleus loses its water content, it collapses. Without the cushion effect of the discs, the vertebrae in your spine would not be able to absorb stresses or provide the movement needed to bend and twist.

collapses, allowing the two vertebrae above and below to move closer to one another. This results in a narrowing of the disc space between the two vertebrae. As this shift occurs, the facet joints (located at the back of the spine) are forced to shift. Shifting changes the way the facet joints work together and can cause problems as well.

Bone spurs, sometimes called osteophytes, may begin to form around the disc space. These can also form around the facet joints. This is thought to be due to the body's response to try to stop the excess motion at the spinal segment. The bone spurs can become a problem if they start to grow into the spinal canal and press into the spinal cord and spinal nerves. This condition is called spinal stenosis.

Learn more about spinal stenosis.

Symptoms

The most common early symptom of degenerative disc disease is usually pain in the back that spreads to the buttocks and upper thighs. When doctors refer to degenerative disc disease, they are usually referring to a combination of problems in the spine that "start" with damage to the disc, but eventually begin to affect all parts of the spine. Problems thought to arise from the degenerating disc itself include discogenic pain, and bulging discs.

Discogenic Pain

Discogenic pain is a term back specialists use when referring to pain caused by a damaged intervertebral disc. A degenerating disc may cause mechanical (or structural) pain. As the disc begins to degenerate, there is some evidence that the disc itself becomes painful. Movements that place stress on the disc can result in back pain that appears to come from the disc. This is similar to any other body part that is injured, such as a broken bone or a cut in the skin. When these types of injuries are held still there is no pain, but if you move them they hurt.

Discogenic pain usually causes pain felt in the lower back. It may also feel like the pain is coming from your buttock area and even down into the upper thighs. The experience of feeling pain in an area away from the real cause is common in many areas of the body, not just the spine. For instance, a person with gallstones may feel pain in the shoulder or a person experiencing a heart attack may feel pain in the left arm. This is referred to as radiation of the pain. It is very common for pain produced by spine problems to be felt in different areas of the body-including the back.

Bulging Discs

Bulging discs are fairly common in both young adults and older people. They are not cause for panic. Abnormalities, such as bulging or protruding discs, are seen at high rates on MRIs in patients both with and without back pain. Some discs most likely begin to bulge as a part of both the aging process and the degeneration process of the intervertebral disc. A bulging disc is not necessarily a sign that anything serious is happening to your spine.

A bulging disc only becomes serious when it bulges enough to cause narrowing of the spinal canal. If there are bone spurs present on the facet joints behind the bulging disc, the combination may cause narrowing of the spinal canal in that area. This is sometimes referred to as segmental spinal stenosis. View animation of bulging disc.

Diagnosis

Before your doctor can diagnose your condition and design a treatment plan, a complete history and physical exam are necessary. There are so many possible causes of pain. It is important to determine what is and is not at the root of the problem.

You may be asked to take a variety of diagnostic tests. The tests are chosen based upon what your physician suspects is causing your pain. The most common diagnostic tests used to diagnose degenerative disc disease are ordinary X-rays and MRI scans. If your doctor suspects disc degeneration, X-rays can be used to verify a decrease in the height of space between vertebrae, bone spurs, facet hypertrophy (enlargement), and instability during flexion or extension of limbs. An MRI can verify loss of water in a disc, facet joint hypertrophy, stenosis, or a herniated disc.

Treatment Options

Conservative Treatment

Treatment will depend on the seriousness of your condition. Some problems need immediate attention-possibly even surgery. The vast majority of back problems do not require surgery. Treatment for your back may be as simple as reassuring you that it is not a serious problem and doing nothing but watching and waiting. In most cases, simple therapies, such as mild pain medications and rest are effective in relieving the immediate pain.

The overall goal of treatment is to

make you comfortable as quickly as possible

design a spine-care program to reduce further degeneration

get you back to normal activity in a timely manner

The more you know about how your back works and what you can do to prevent further injury, the more effective your program will be.

Specific Rest

Immediately after a back injury, rest is often all your back needs to feel better. Rest is used to take the pressure off your spine and the muscles around it. You should rest in a comfortable position on a firm mattress. Placing a pillow under your knees can also help relieve pain. Do not stay in bed for several days. Bed rest for more than two or three days can weaken the back muscles, making the problem worse instead of better. Even though you may still feel some pain, a gradual return to normal activities is good for your muscles. In most cases of sudden back pain, the sooner you start moving again, the sooner your back pain will improve. If you are sent to see a physical therapist, the first few days may be spent educating you on ways to take stress off the back, while remaining as active as possible. Short periods of rest combined with brief exercises designed to reduce your pain may be suggested.

Physical Therapy and Exercise

Your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.

Therapy visits are designed to help control symptoms, enabling you to begin moving and exercising safely and easily. Regular exercise is the most basic way to combat back problems. Consider it part of long-term health management and risk reduction program. Exercises focus on improving strength and coordination of the low back and abdominal muscles. The emphasis of therapy is to help you learn to take care of your back through safe exercise and self care when symptoms flare up. Therapy sessions may be scheduled two to three times each week for up to six weeks.

The goals of physical therapy are to help you

learn ways to manage your condition and control symptoms

maintain appropriate activity levels

learn correct posture and body movements to reduce back strain

maximize your flexibility and strength

Learn more about spinal rehabilitation.

ESI

An epidural steroid injection (ESI) can be used to relieve the pain of stenosis and irritated nerve roots, as well as to decrease inflammation. Injections can also help reduce swelling from a bulging or herniated disc. The steroid injections are a combination of cortisone (a powerful anti-inflammatory steroid) and a local anesthetic that are given through the back into the epidural space. ESIs are not always successful in relieving symptoms of inflammation. They are used only when conservative treatments have failed.

http://www.allaboutbackpain.com/html/spine_lumbar/ spine_lumbar_ddd.html


07/19/2009 11:11 AM
bits
bits  
Posts: 10912
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hat

Thank you.

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