Degenerative disc disease is a problem affecting millions of Americans. It is never fatal and surgery for it is not absolutely vital. The discs between the vertebra (intervertebral discs) in the lumbar spine provide an extremely important cushioning function. Between each vertebra there is a disc which consists mostly of water and collagen. These discs cumulatively permit substantial range of motion. Think of all the different directions you can twist and turn.
As one ages, overall a person starts to lose water and the discs are no exception. It doesn't get fully replaced so the discs lose height as they become dehydrated. Most human organs and body parts have an active metabolism. For example, the human mouth mucosal cells get replaced every week, and cerebrospinal fluid is replaced every 6 hours.
The intervertebral disc maintains a very slow metabolism which comes with a very limited healing capability. A study has been done evaluating patients in their 30's and 40's and their incidence of DDD. Interestingly, of patients in their 40's over 40% have signs of degenerative disc disease on MRI and none of them had back pain at all.
So just having an MRI showing degenerative disc(s) does not indicate a person will have back pain. An individual may have very bad pain with only insignificant showing of degenerative disc or it could be the other way around. One of the co-existing conditions individuals may be dealing with is facet disease. The intervertebral disc is in the front spine area, and the facet joints are in the back of the spine. If an individuals's disc is losing height and dehydrating, the facet joints may begin to experience abnormal amounts and type of motion. This can end up in arthritis and pain in the facet joints.
If a patient is having low back pain with signs of degenerative disc disease on an MRI, the facet joints should be evaluated for signs of arthritis. But that can be elusive as well. A pain management doctor may perform a diagnostic injection in the area around the joint to see if the facet joint is actually the problem.
There really isn't a standard diagnostic injection for the intervertebral lumbar disc. The patient may have a procedure termed a discogram which can help diagnose the disc as the source of pain. The doctor injects fluid into the disc to see if it reproduces the patient's pain. If the answer is yes, the disc can be ascertained as the patient's pain source.
Degenerative disc disease surgery currently consists of 2 options. One is to perform an artificial disc replacement, the second is a spinal fusion. In 2004 the FDA approved artificial disc replacement for the lumbar spine, and the hope was it would be a veritable new frontier for DDD. So far, that has not been the result. Good results have been about 70% good to excellent for both procedures.
The bottom line here is that low back pain from degenerative disc disease does not always correlate to the degree of the degeneration seen on imaging studies. The patient's subjective complaints are more important than the MRI.
As one ages, overall a person starts to lose water and the discs are no exception. It doesn't get fully replaced so the discs lose height as they become dehydrated. Most human organs and body parts have an active metabolism. For example, the human mouth mucosal cells get replaced every week, and cerebrospinal fluid is replaced every 6 hours.
The intervertebral disc maintains a very slow metabolism which comes with a very limited healing capability. A study has been done evaluating patients in their 30's and 40's and their incidence of DDD. Interestingly, of patients in their 40's over 40% have signs of degenerative disc disease on MRI and none of them had back pain at all.
So just having an MRI showing degenerative disc(s) does not indicate a person will have back pain. An individual may have very bad pain with only insignificant showing of degenerative disc or it could be the other way around. One of the co-existing conditions individuals may be dealing with is facet disease. The intervertebral disc is in the front spine area, and the facet joints are in the back of the spine. If an individuals's disc is losing height and dehydrating, the facet joints may begin to experience abnormal amounts and type of motion. This can end up in arthritis and pain in the facet joints.
If a patient is having low back pain with signs of degenerative disc disease on an MRI, the facet joints should be evaluated for signs of arthritis. But that can be elusive as well. A pain management doctor may perform a diagnostic injection in the area around the joint to see if the facet joint is actually the problem.
There really isn't a standard diagnostic injection for the intervertebral lumbar disc. The patient may have a procedure termed a discogram which can help diagnose the disc as the source of pain. The doctor injects fluid into the disc to see if it reproduces the patient's pain. If the answer is yes, the disc can be ascertained as the patient's pain source.
Degenerative disc disease surgery currently consists of 2 options. One is to perform an artificial disc replacement, the second is a spinal fusion. In 2004 the FDA approved artificial disc replacement for the lumbar spine, and the hope was it would be a veritable new frontier for DDD. So far, that has not been the result. Good results have been about 70% good to excellent for both procedures.
The bottom line here is that low back pain from degenerative disc disease does not always correlate to the degree of the degeneration seen on imaging studies. The patient's subjective complaints are more important than the MRI.
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