Covers causes and symptoms of changes in your spinal discs as you age. Includes changes that can result in back or neck pain, osteoarthritis, herniated disc, and spinal stenosis. Looks at treatment with nonsteroidal anti-inflammatory drugs.
Degenerative Disc Disease
What is degenerative disc disease?
Degenerative disc disease is not really a disease but
a term used to describe the normal changes in your spinal discs
as you age. Spinal discs are soft,
compressible discs that separate the interlocking bones (vertebrae) that
make up the
spine. The discs act as shock absorbers for the spine,
allowing it to flex, bend, and twist. Degenerative disc disease can take place
throughout the spine, but it most often occurs in the discs in the lower back
(lumbar region) and the neck (cervical region).
The changes in the discs can result in back or
neck pain and/or:
These conditions may put pressure on the spinal cord and
nerves, leading to pain and possibly affecting nerve function.
What causes degenerative disc disease?
As we age,
our spinal discs break down, or degenerate, which may result in degenerative
disc disease in some people. These age-related changes include:
The loss of fluid in your discs. This reduces
the ability of the discs to act as shock absorbers and makes them less
flexible. Loss of fluid also makes the disc thinner and narrows the distance
between the vertebrae.
Tiny tears or cracks in the outer layer
(annulus or capsule) of the disc. The jellylike material inside the disc
(nucleus) may be forced out through the tears or cracks in the capsule, which
causes the disc to bulge, break open (rupture), or break into fragments.
These changes are more likely to occur in people who
smoke cigarettes and those who do heavy physical work (such as repeated heavy
lifting). People who are
obese are also more likely to have symptoms of
degenerative disc disease.
A sudden (acute) injury leading to a
herniated disc (such as a fall) may also begin the degeneration process.
As the space between the vertebrae gets smaller, there is less padding
between them, and the spine becomes less stable. The body reacts to this by
constructing bony growths called bone spurs (osteophytes). Bone spurs can put
pressure on the
spinal nerve roots or spinal cord, resulting in pain
and affecting nerve function.
What are the symptoms?
Degenerative disc disease
may result in back or neck pain, but this varies from person to person. Many
people have no pain, while others with the same amount of disc damage have
severe pain that limits their activities. Where the pain occurs depends on the
location of the affected disc. An affected disc in the neck area may result in
neck or arm pain, while an affected disc in the lower back may result in pain
in the back, buttock, or leg. The pain often gets worse with movements such as
bending over, reaching up, or twisting.
The pain may start after a
major injury (such as from a car accident), a minor injury (such as a fall from
a low height), or a normal motion (such as bending over to pick something up).
It may also start gradually for no known reason and get worse over time.
Degenerative disc disease is diagnosed with a medical history and
physical exam. Your doctor will ask about your symptoms, injuries or
illnesses, any previous treatment, and habits and activities that may be
causing pain in the neck, arms, back, buttock, or leg. During the physical
exam, he or she will:
Check the affected area's range of motion and
for pain caused by movement.
Look for areas of tenderness and any
nerve-related changes, such as numbness, tingling, or weakness in the affected
area, or changes in
Check for other conditions, such
as fractures, tumors, and infection.
If your exam reveals no signs of a serious
imaging tests, such as an
X-ray, are unlikely to help the diagnosis. Imaging
tests may be considered when your symptoms develop after an injury, nerve
damage is suspected, or your medical history suggests conditions that could
affect your spine, such as bone disease, tumors, or infection.
How is it treated?
To relieve pain, put ice or
heat (whichever feels better) on the affected area and use
acetaminophen (such as Tylenol) or
nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen. Your doctor can prescribe stronger medicines if
If you develop health problems such as osteoarthritis, a herniated disc, or
spinal stenosis, you may need other treatments. These include physical therapy and exercises for strengthening and stretching the back. In some cases, surgery may be recommended. Surgery usually involves removing
the damaged disc. In some cases, the bone is then permanently joined (fused) to
protect the spinal cord. In rare cases, an artificial disc may be used to replace
the disc that is removed.
Fast A, Segal M (2008). Cervical degenerative disease. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 11–15. Philadelphia: Saunders Elsevier.
Hellum C, et al. (2011). Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: Two year follow-up of randomised study. BMJ. Published online March 25, 2011 (doi:10.1136/bmj.d2786).
Roh JS, et al. (2005). Degenerative disorders of the
lumbar and cervical spine. Orthopedic Clinics of North America, 36(2005): 255–262.
Schaufele MK, Walsh AH (2008). Lumbar degenerative disease. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, 2nd ed., pp. 229–235. Philadelphia: Saunders Elsevier.
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
How this information was developed to help you make better health decisions.