Lumbar Degenerative Disc Disease

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Lumbar (low back) degenerative disc disease (DDD) is common in aging adults.  The intervertebral discs serve as the spine’s shock absorbers and, as we naturally age, discs gradually dry out, lose strength and resiliency.

Symptoms

DDD contributes to loss of disc height.  This means the space between two vertebral bodies is less.  When disc height is lost, there is less room for spinal nerves.  Other problems develop, such as bone and joint inflammation, and development of bone spurs (osteophytes).  Low back pain is a primary symptom, however pain may travel into the buttocks, thighs and legs.  Pain may be accompanied by tingling sensations, numbness, and weakness.

Video Degenerative Disc Disease
Click below to view a video from our library about this condition.

Diagnosis

Lumbar DDD should be diagnosed by a spine specialist. This typically involves the following steps.

• Medical History 
  The doctor asks you about symptoms, their severity, when back and/leg pain started, and treatments you tried and results.

• Physical Examination
  The physician examines you for movement limitations, problems with balance, pain.  He tests your reflexes, muscle strength, sensation, and signs of neurologic dysfunction.

• Diagnostic Tests
  X-rays reveal loss of disc space between the vertebral bodies  In some cases, a test called discography confirms the diagnosis. Discography involves injecting contrast dye into the affected disc (or discs) to create a clearer image and temporarily replicate symptoms.

Non-operative Treatment

Most cases of lumbar degenerative disc disease do not require surgery.  Non-operative treatments include:

• Medications: anti-inflammatory drugs help reduce swelling and pain, muscle relaxants calm spasm, and occasionally narcotic painkillers to reduce acute pain.  
• Cold/heat therapy, especially during the first 24 to 48 hours.
• Spinal injections
• Physical therapy: gentle massage, stretching, therapeutic exercise, bracing, or traction to decrease pain and increase function.
• Chiropractic or alternative therapy (i.e., acupuncture).

During physical therapy, patients are taught proper posture and body mechanics to help prevent future back pain.

Surgical Treatment

If symptoms of lumbar DDD persist despite non-operative treatments, further diagnostic tests may be necessary.  Tests may include a CT scan, MRI, myelogram, or discography.  If  one or more intervertebral discs is damaged, causes pain or other symptoms (e.g., muscle weakness), surgery may be necessary.  The surgical procedure may include a discectomy (remove the damaged disc) and interbody fusion.  Interbody fusion replaces the empty disc space with bone graft and/or a cage (or other similar device).  Bone graft stimulates new bone growth and causes two vertebral bodies to heal together.

Many procedures are performed using minimally invasive techniques, which can help speed your recovery. The surgeon tells you about the risks and benefits of your surgical options.

Conclusion

While lumbar DDD is a natural part of aging, it does not mean that low back pain is a natural part of life. Much is known about this condition and there are many effective treatment options. Some patients may be candidates for surgery, which should be undertaken only with a thorough understanding of the potential risks and benefits of an operation.