Degenerative Disc Disease
Discs are soft, gelatin-like pads located between the hard bones or vertebrae that make up the spinal column, which encases the spinal cord and nerves. Discs function as shock absorbers when you flex, rotate, or bend your back or neck, and they begin to degenerate as we age. The gel-like substance called the nucleus may thin to the point where there is insufficient padding between verterbrae. Another common spinal condition is herniated nucleus pulposus, often referred to as a “ruptured” or “slipped” disc. It occurs when the disc, the shock absorber between the bones of the spine spills over into the spinal canal, causing compression of one of the spinal nerves. It may be caused by trauma, stress to the area or degenerative changes over time. In general, disc herniation symptoms may intensity with coughing, sneezing, or sitting.
A cervical or neck disc herniation may cause pain, tingling, numbness, weakness in the neck, arms or hands if compressing a nerve. If it compresses the spinal cord it can cause weakness in the legs as well. A lumbar disc herniation in the lower back may send pain shooting pain into the buttocks or down the leg, local severe back pain, burning in the back, weakness in one leg or both legs, changes in bowel or bladder activity, and lack of sensation or pins-and-needles tingling in one or both legs. Thoracic disc herniations, which affect the upper spine are less common than cervical or lumbar disc herniations, and often discovered as a secondary diagnosis. Often asymptomatic, they may be tricky to diagnose and could be a ticking time bomb if the herniation progresses to compress the spinal cord itself which could lead to paralysis of the legs.
Surgical treatment includes a microdiscectomy, a minimally invasive procedure, to remove the disc. Another option is implanting an artificial disc, made of metal and plastic, to maintain mobility of the spine. In the past couple of years it has become more frequently utilized in cervical spinal surgery, but your spine surgeon will help you determine if that is the best option for you. Sometimes spinal fusion is the best choice. New techniques in spinal fusion surgery make it less traumatic and recovery may be significantly shorter.
In older patients, spondylolysis is caused by degeneration of the joints and discs in a part of the vertebrae known as the pars, usually involving the fourth or the fifth lumbar vertebra in the lower back. Spondylolysis may allow the vertebral bones to slip, one over the other, throwing the spine out of alignment. This is a condition called spondylolisthesis and may result in severe localized pain in the back as well as pain in the legs. In young people, spondylolysis may be a result of a stress fracture most commonly seen in active athletes, such as gymnasts, weightlifters, football players and dancers. It can be congenital or be caused by trauma.
Patients with spondylolysis may feel slight to severe back pain, particularly across the lower back, muscle spasms, back stiffness, tightening of the hamstrings, nerve compression, and changes in posture.
Treatment options include rest, physical therapy, medication, chiropractic care, steroid injections or surgery, such as discectomy, laminectomy or spinal fusion. Cardiovascular exercise, maintaining a healthy weight and a regimen to improve strength and flexibility in the area of herniation may help relieve symptoms and prevent muscle spasms in the future.