DEGENERATIVE DISEASE

Disc degeneration may cause no symptoms, or the pain may be so intense that the individual cannot continue with their daily activities.

The condition starts with damage to the spine, but in time, symptoms can affect other parts of the body. Symptoms usually get worse with age.

The discomfort can range from mild to severe and debilitating. It can lead to osteoarthritis, with pain and stiffness in the back.

The most common early symptom is usually pain and weakness in the back that radiates to another area.

If the damage is in the lower back, or lumbar spine, the discomfort may radiate to the buttocks and upper thighs. There may also be tingling, numbness, or both, in the legs or feet.

If the damage is in the neck area, or cervical spine, the pain may spread to the shoulder, arm, and hand.

There may also be instability in the spine, leading to muscle spasms in the lower back or neck, as the body tries to stabilize the vertebrae. This can be painful.

The individual may experience flareups of intense pain.

The pain may be worse when sitting, bending, lifting, or twisting. Walking, lying down, and changing position may help relieve it.

The main reason to perform more tests is if the symptoms are getting worse despite treatment, if the pain is severe or if you have signs of nerve damage — particularly nerve damage that is getting worse. The signs of worsening nerve damage would be increasing tingling or numbness, weakness and sometimes increasing pain. If the physician is concerned that you might have a pinched nerve, then the best tests would be an MRI of the neck or occasionally a computed tomography (CT) scan. Another test that can be done to see if the nerves are involved is called an electromyography (EMG) or a nerve conduction study (NCS). In these two tests, a physician uses instruments to evaluate the muscles and nerves to see if they are carrying the signals from the spine to the arms properly. This test can evaluate several different nerves in your arms to see if the nerve is pinched at the neck or at some other place, such as the wrist (a condition called carpal tunnel syndrome).

Since the causes of degenerative spine conditions will vary from patient to patient, no two treatments will be identical.

Before surgery is considered, nonoperative treatments may be recommended. These measures include:

• Medications (pain medications, anti-inflammatory medications, antidepressants, anticonvulsants, non-steroidal anti-inflammatory drugs (NSAIDs), topical opioids, and/or epidural injections of steroids or pain medication)

• Bracing

• Activity modification

• Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disc)

• Physical therapy (will focus on strengthening the muscles of the back/neck and improving flexibility as well as range of motion)

• Weight control

In some cases, surgery may be recommended or required to treat a degenerative condition. The type of procedure depends on the type of condition and its severity. Surgery is considered when:

• A patient’s symptoms do not respond to nonoperative measures

• A patient’s pain is severe

• Myelopathy is present

In such cases, surgery has the potential to relieve pain, prevent further damage to the spinal cord, and drastically improve a patient’s quality of life. Procedures include:

• Anterior cervical discectomy with fusion (ACDF)

• Anterior cervical corpectomy with fusion

• Laminectomy to remove bone spurs or a section of the lamina (part of the vertebral arch) to make room for the spinal cord

• Laminoplasty to remove part of the lamina to make room for the spinal cord

• Discectomy

• Foraminotomy

In some situations, the surgeon may also need to perform a spinal fusion to ensure the spinal column is stable. During a spinal fusion, the surgeon will place a bone graft between the vertebrae to cause the bones to fuse.