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Degenerative Disc Conditions

Pain, General | February 20, 2015 | Author: The Super Pharmacist

Pain

Degenerative Disc Conditions

The spinal disc allow a certain range of motion and contribute to the overall movement of the spine, however discs may may be subject to many disorders and diseases. Degenerative disc disease may result in pain and reduced functional capacity and loss of work. 

The vertebrae are the bones that make up what is commonly referred to as the spine. These small bones 'line up' to form a single canal (or column) through which the spinal cord may run. These spinal bones are present to support and protect the spinal cord, and also allow for upright body positions.

The bones are separated by thick layers of tissue, in the form of discs, called intervertebral discs, which play a role in protecting the bones from shocks and prevent direct contact between vertebrae. Intervertebral discs are made up of a tough, resilient layer (the annulus fibrosus) and a softer, more pliant inner ring (the nucleus pulposus). They sit on the body (the 'solid half' that does not contain the gap for the spinal cord) of a vertebrae.

These discs play important roles in allowing a certain range of motion in one bone relative to another and contributes to the overall normal movement of the spine. However, discs may be subject to many disorders and diseases some of these include:

  • Risk Factors for Degenerative Disc Disease:Disc herniation: A condition in which the annulus fibrosus weakens, allowing the nucleus to protrude outward. This may result in chronic pain if it comes into contact with the spinal cord or spinal nerves.
  • Degenerative disc disease: An intervertebral disc may also be subject to degenerative disc disease. This is the deterioration (or progressive loss) of the cells and molecular materials that make up the disc, over time.
  • Increased fluid loss from the nucleus pulposus: Degenerative disc disease may also be associated with increased fluid loss from the nucleus pulposus. This may cause deformations in this part of the disc, which may further affect its ability to regenerate disc material and to support the vertebra.

Degenerative disc disease may be associated with other biochemical changes within or around the disc, such as:

  • Increased inflammation, which may contribute to pain
  • Increased breakdown of the molecules that form the structure of a disc
  • Reduced concentrations of collagen, a major component of the annulus fibrosus
  • Reduced concentrations of glycosaminoglycans, which form proteoglycans, a component of the nucleus pulposus
  • Reduced concentrations of oxygen in disc tissues

Degenerative disc disease is considered to be irreversible by some researchers and may lead to other spinal conditions, such as spinal stenosis, in which the spinal cord becomes increasingly compressed or encroached on by other tissues surrounding it. Stenosis may become a source of chronic pain, sensory deficits or motor impairment.

Diagnosing Disc Degeneration

Disc degeneration is typically diagnosed using imaging techniques such as magnetic resonance imaging (MRI). Its symptoms and effects on functional status are assessed based on patient reports and rating scales such as the Oswestry disability index.

Risk Factors for Degenerative Disc Disease

Age: Intervertebral disc disease often progresses with time.

Risk Factors for Degenerative Disc DiseaseEmployment in occupations involving manual labour such as construction or farming.

Lifting weights - especially if these are steadily increased over time. 

Discectomy: A history of having undergone a discectomy may increase the risk of developing degenerative disc disease later in life. A discectomy is a procedure to remove part of a disc that has become herniated or damaged.

Treatment of Degenerative Disc Disease

Intervertebral disc degeneration may be addressed with a number of treatments and applications. These may include:

Conservative therapy

This may be a first line of treatment offered to patients with mild to moderate pain associated with degenerative disc disease. These often consist of non-surgical treatments such as physical therapy and chiropractic manipulation. A double-blind trial assigned 40 adult male patients with degenerative discs in the lower back to spinal manipulation or a placebo treatment. This resulted in a significant decrease in subjective pain, as well as an improvement in spinal height and mobility in the treatment group only.

Spinal fusion

This is a procedure in which vertebrae with degenerating discs may be joined together. This is thought to reduce motion and bone-on-bone friction, and thus pain, in the area of the spine affected. Spinal fusions are often completed using surgical screws, bone grafts from the patient (or donor), or by fusing joints together (arthrodesis). A systematic review and analysis compared donor-derived graft fusion to arthrodesis using molecular medicine to induce bone growth. This showed that fusion using grafts was associated with significantly greater complications and pain. In addition, the need for further surgery and risk of non-fusion following this procedure were twice those associated with arthrodesis.

Discectomy

This is a procedure in which the part(s) (or segments) of a damaged or degenerated disc is surgically removed. It may be accompanied by spinal fusion. However, discectomy may increase the risk of new-onset degeneration in different sections, as outlined above.

Disk replacement

This is a procedure in which damaged discs are removed and a replacement prosthesis is implanted. A clinical trial compared conventional discectomy and/or fusion procedures to artificial disc implantation. A total of 202 artificial disc patients and 89 discectomy/fusion patients completed the follow-up in this study. This data showed that the artificial disc procedure was associated with significantly greater success and patient satisfaction, and with significantly reduced disability, compared to the conventional treatment. This treatment is safe and effective, when replacing a single disc. However, replacing more than one disc with a prosthesis is thought to be linked to an increased risk of complications, although this may lead to significant improvements in spinal rotation and function.

Epidural steroid injections

Epidural steroid injectionsThese are administrations of corticosteroid drugs directly into the periphery of a vertebra affected by disc degeneration. These injections reduce pain by inhibiting the formation of inflammatory molecules around a damaged disc and the spinal nerve root that transmits painful stimuli to the brain as a result of this. Epidural steroid injections are commonly recommended in cases of persistent pain caused by intervertebral disc damage.

Spinal decompression

These are procedures in which pressure on the spinal cord associated with stenosis and/or disc degeneration is relieved. This is most often completed using conventional microsurgery. However, newer forms of decompression may involve implants to prevent encroachment on the spinal cord. A multi-centre trial assigned 542 patients with disc degeneration in the lower back to conservative treatment (120 patients) or to a new form of decompression using implantable devices. This resulted in positive responses in 84% of the implant group compared to 50% of the control group.

Emerging Treatments

Some new applications to address and reverse degenerative disc disease are currently being tested or proposed in the literature. This includes stem cell therapy. Some initial studies have shown the potential of cells that differentiate into a type that can produce molecules to repair the existing structure of a disc (e.g. proteoglycans).

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References

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