In the spine, the bones of the vertebral bodies are cushioned from one another by an intervertebral disc. The disc is a soft structure comprised of thirteen concentric layers of collagen (annulus) surrounding the jelly-like shock absorbing disc center (nucleus). As part of the normal aging process, progressive changes develop in the intervertebral discs. These changes, termed degenerative disc disease, lead to loss of disc height, loss of water content, loss of the shock absorbing capacity of the disc, and bone spur formation. Degenerative cervical and lumbar disease affects everyone; however, the pain pattern can differ greatly between patients. In some patients, there is very little discomfort and only a feeling of progressive stiffness, while in others, pain is the dominant symptom.
Typically, the low back pain associated with lumbar degenerative disc disease tends to radiate horizontally across the low back and is exacerbated by prolonged sitting or standing. Many patients find relief from the pain of degenerative disc disease when they are lying down or reclining. Similarly, the neck pain caused by cervical degenerative disc disease tends to radiate from the neck out toward the shoulders. It typically worsens over the course of the day and is also relieved by lying down.
Although it appears to be an aging phenomenon, different experts believe that the discs have various pain patterns secondary to inflammation. This inflammation causes the irritation of the nerve endings that enter the annulus fibrosus (outer layer of the disc). The body tries to deal with the inflammation by forming scar tissue in the area. Over time, the progressive loss of height causes friction between the vertebrae. Bone spurs, then, form at the front and back of the vertebral bodies with the goal of actually forming bone to bridge across the disc space, causing more pain. Many times, MRI scans will identify the extent of degenerative disc disease in either the neck or the low back, and procedures such as discography can be performed in an attempt to identify specific pain generators.
There are a number of treatment options for degenerative disc disease, whether it be cervical or lumbar. Many times, a combination of anti-inflammatories and physical therapy is all that is necessary. There is also some value to manual physical therapy and chiropractic manipulation. If needed, stronger pain medications and corticosteroid injections can be performed. In patients who are refractory to all of these interventions, surgery becomes a real option.
- Brian R. Subach, MD, FACS; Virginia Spine Institute
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