Degenerative Disc Disease

Having attended the NSpine 2013 conference last week we came away with a mass of updated information regarding low back pain, surgical techniques, new research and procedures available to our patients.  It was fantastic to be listening to the same speakers as some of the most highly regarded surgeons in the world.

A lot of the talks focussed on degenerative disc disease (DDD) which is what this blog will be about.

Discs can degenerate for a number of reasons but unfortunately there is a strong genetic link. You are at higher risk of low back pain if you have a family history of DDD.

In DDD, it is thought that the discs dehydrate leading to a reduction in pressure in the discs.  This allows the disc to be more vulnerable to stress, therefore creating tears in the annulus. As a result rotation is very poorly controlled in the damaged segment. In turn this means the facet and capsule, that is attached to the facet hypertrophies, (becomes larger).  The next stage is then osteophyte formation which is the bodies attempt to re-stabilise the area. 

As part of this process if there is enough material in the centre of the disc and it 'leaks' out through theses tears this material can press on a nerve root leading to nerve compression.

All in all this can present clinically as low back pain with or without leg symptoms. It can be a chronic problem where people have pain for many years. 

One option to help DDD maybe surgery where the spinal consultants perform a fusion. (see image below).  Here they remove the interverbral disc and take a piece of bone, normally from your iliac crest/'hip' bone to use instead.  They place this part of bone where the disc was and use a system of screws and metalwork to hold it in place.  The end result is a 'fused' segment or segments depending on how many discs are affected.  The range of movement is lost at that segment but nearly normal mobility remains due to the movement in the rest of the spine and hips.

 

 

This unfortunately has only a 60% success rate with one in four patients having some remaining pain and/or disability after.  Often and particularly depending on the patients general health, the surgeons would prefer not to operate as the function, indicated by daily activities the person performs, one year after surgery is equal to the group of patients who had only conservative management ie./ manual therapy.