Degenerative Disc Disease

Degeneration of the spine is part of the normal aging process. You may want to read the section in this web site on "the aging spine". When significant pain develops which is directly related to a degenerating disc then this condition has been termed Degenerative Disc Disease (DDD). It is not quite clear why disc degeneration is painful in some people and appears to go quite unnoticed in others. Possible explanations may include: instability of the spine with disc degeneration in some people, in-growth of scar tissue into a degenerating disc which brings sensitive nerve fibers with it (and thus a source of pain), painful arthritis of the facet joints in some people.

A thorough evaluation is crucial in any patient with back pain. Proper X-rays are helpful to assess not only the alignment of the spine but also any instability (or excessive and abnormal motion between vertebrae ). An MRI can be useful to assess the soft tissues not seen on x-rays, such as the discs, ligaments and other elements.

If an evaluation and tests point toward DDD as the source of pain, then treatment approach can be outlined. A first step to treating DDD is often physical therapy, medication and bracing. Occasionally, epidural injections may offer some relief. If non-operative means have been pursued and fail then a discogram-CT test is sometimes considered. This is a test that involves an injection of contrast solution into the suspected disc followed by a CT study. If the usual type of pain is reproduced by this test and the adjacent discs are normal then surgical treatment is sometimes considered. This may consist of a fusion, and often a removal of the degenerated painful disc. Surgical treatment can be effective for carefully selected patients that have failed all other treatments.

Frequently Asked Questions