Spinal discs are the cushion that separates the bones of the spine. When spinal disks degenerate, you may have back pain and stiffness, tingling or numbness.
This condition is common. In the early stages, degenerated spinal disks are asymptomatic. MRI and CT scans show alterations such as desiccation, fibrosis, cleft formation in the anulus and fissuring of the apophyses.
Causes
Each bone in the spine, called a vertebrae, is separated from one another by shock-absorbing spinal discs. Each disc looks a bit like a jelly doughnut, with a tough outer layer (annulus fibrosus) and a soft center (nucleus pulposus). During normal movements, the spinal bones rub against each other and this can cause pain. A degenerated or herniated disk can also press on spinal nerves and this can cause pain, tingling, or weakness in the back or neck. Degeneration of a spinal disc is common and it usually does not lead to long-term disability in most people.
The condition is caused by natural, age-related wear and tear on the spinal disks. The discs start to dry out and shrink with age and this can cause the outer portion of the disc to begin to tear. As the tearing continues, the outer layer can break down and the nucleus may leak out. The discs that are in the lower part of the spine, in the lumbar region, tend to degenerate first. As this stage progresses, you will start to feel back pain and it will become more consistent and intense.
At this point, your body tries to compensate for the loss of a spinal disc. Your body will form bony projections, called osteophytes, that grow along the edges of the bones in the spine. These osteophytes can press on the spinal nerves or spinal cord and cause pain, tingling, and weakness.
During this stage, you will probably need to use a cane or walker to help support your weight and reduce the stress on your spine. This will not prevent the progression of the condition, but it will slow down the process and allow your spine to heal more quickly.
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At this stage, your doctor will ask you about the intensity and frequency of your pain. Your doctor may also do a physical exam and touch the parts of your back that hurt or to see how your muscles react. Your doctor may order an X-ray or magnetic resonance imaging (MRI) of your spine and look for signs of damage or a herniated or degenerated spinal disc. They may also perform a test that measures how well you respond to stimulation of the nerves in your back, such as a reflex hammer.
Symptoms
As people age, their spinal disks naturally degenerate. This is a normal part of aging, but the deterioration can cause pain and stiffness. This is often a result of the stress that is placed on the spine during everyday movements, such as walking, sitting and lifting.
The spine is made up of five bones called vertebrae that are separated by intervertebral discs. The discs help absorb pressure during movement and act as a cushion between the vertebrae. Eventually, the wear and tear on the spinal disks leads to loss of fluid and shrinking of the disks. This can lead to a narrowing of the space in which the spinal cord and nerves pass through the spine. This is known as spinal stenosis.
People with a herniated disc experience pain in the area of the damaged disk. This pain can be mild, moderate or severe. It may also be constant or intermittent. The pain is often worse when sitting for long periods of time or when bending, twisting and lifting. Occasionally, the pain can extend to the arms and legs.
Spinal disk problems occur more frequently in the parts of the spine that move the most, such as the lower back or neck. The most common early symptoms are pain and weakness in the back or neck. The pain can spread to the buttocks or upper thighs if the damage occurs in the lower spine, or to the arms and hands if it is located in the neck.
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Over-the-counter pain relievers like aspirin and ibuprofen can ease pain and reduce swelling. Your doctor may also prescribe stronger medication if you need it. Muscle spasms in the back or neck can also be a symptom of degenerative spine disease.
Your doctor will ask you about your past health, symptoms and lifestyle. Then, they will do an exam of your back and neck. They will ask you to bend, walk and lift objects to see how your spine moves. They will also order X-rays of your spine, which will show the shape of the vertebrae and any bone changes. They may also order flexion-extension X-rays, which are taken while you bend and straighten your spine, or lateral X-rays, which will show the front and sides of your spine.
Diagnosis
While degenerative spine disease is a common condition, there are many ways to treat it. At OHSU Spine Center, we are committed to trying the least-invasive options first. We offer pain control programs, exercise, physical therapy and medications. We can help you find the right treatment for your needs and goals.
The spinal disks are rubbery cushions between the vertebrae (bones in your spine) that allow you to bend, twist and move without hurting. Over time, everyone’s spinal discs wear down. This is a normal part of aging and does not cause back pain in most people. If the degenerated disc presses on a nerve, it can cause symptoms such as pain, numbness and weakness.
A small tear or crack in the outer wall of a spinal disk may cause it to bulge out, or herniate. A herniated disk can put pressure on spinal nerves and lead to pain, numbness or weakness in the arms, legs, chest, butt or back.
When you have pain that is caused by spinal disks, a diagnosis is made through a physical exam and a history of the symptoms you’re experiencing. We may also order imaging tests, such as a magnetic resonance imaging (MRI) scan or computed tomography (CT) scan. These tests provide a detailed picture of the bones in your spine and help your doctor see how the disks and nerves are affected by degenerative spinal conditions.
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A MRI or CT scan can show if a herniated disk is putting pressure on a spinal nerve. A herniated disk can also compress the spinal cord, causing weakness, numbness and problems with walking or balance.
X-rays can show if there are changes in your spine such as a curve called adult scoliosis or the space around your spinal nerves narrowing, which is called spinal stenosis. We can also check for a condition called spondylolisthesis, which is when one vertebrae shifts forward or backward over another.
When conservative treatments don’t work or the condition worsens, surgery may be recommended. There are a number of surgical procedures that can be done to relieve pressure on the spinal nerves and stabilize the area. At OHSU Spine Center, our specialists are trained in the latest minimally invasive techniques that can result in faster recovery and less pain.
Treatment
Treatment focuses on decreasing pain, stabilizing the spine and improving or maintaining mobility. Your doctor may recommend a combination of approaches, including physical therapy, pain management techniques and spinal injections. Medications such as nonsteroidal anti-inflammatory drugs (such as aspirin or ibuprofen) and muscle relaxants can decrease inflammation, reduce swelling and relieve pain. Heat therapy, such as a hot water bottle or using a Jacuzzi can increase blood flow to the spine, relieve stiffness and promote healing.
The most common symptom of degenerative disk disease is back or neck pain. Your doctor will take your medical history and do a physical exam. They will look for tenderness in your spine and ask you to bend or move in certain ways to see what types of movements cause pain. Your doctor may also order an X-ray or magnetic resonance imaging (MRI) of your spine. This allows them to view your discs, nerves and spinal canal space. They can identify if your problem is caused by a herniated, or ruptured, disk. They can also determine if your problem is causing spinal stenosis, where the space in the spine narrows.
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If your pain is caused by spinal stenosis, you may be referred to a specialist, called a neurosurgeon, who can perform more invasive tests to pinpoint the source of your pain. They may use a procedure called discography and computed tomography (CT), which involves injecting the spine with dye and taking a CT scan to identify painful areas.
Over time, the body responds to the changes in the spinal discs by forming bony growths around them. These growths, called bone spurs, can press on the spinal cord and nerves, which causes weakness in the legs and numbness. Surgery can relieve the pressure on the spinal cord and nerves.
Surgery is most often recommended when only one or two spinal discs are damaged. This gives the spine more stability and can help prevent serious complications such as paralysis, loss of bladder or bowel control. In some cases, your doctor may suggest surgery if other treatments have not worked for six months or if you develop a condition called cauda equina syndrome, which is when a bundle of nerves in the lower spine becomes compressed.
