What is Lumbar Degenerative Disc Disease?

Lumbar degenerative disc disease is known by lots of different names, they include:

  • Spinal Disc Degeneration
  • Lumbar spondylosis
  • Changes of age
  • "Wear and tear"

These are all more or less the same thing - and I know that some of them sound alarming. However, lumbar degenerative disc disease and changes of age in your spine are very common - in fact NEARLY ALL of us will, in time, get these changes in our spines. It's as inevitable as getting grey hair and wrinkles - it's going to happen.

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Degenerative disk disease is rarely serious

Normally the changes occur quite gradually and cause no serious ill effects. Normal, young discs contain water, the amount varies across the day and discs tend to be a bit thicker in the mornings as they have re hydrated overnight.

But as we age the discs in our lower back naturally become more dehydrated and thinner, this can show on an X-Ray as narrowing of the disc space. This is entirely normal. X-Rays are good for showing bones and spaces, they don't show us any soft tissues and they don't show us lumbar discs either. All you can see on X-ray is the space where the disc sits.

X-ray of the lower back

X-Ray of a lumbar spine showing the gap where the disc sits

MRI scans do however show the disc and in this example below you can see the characteristic narrowing of the disc space with a loss of fluid levels that is typical in degenerative disc disease

MRI scan of lower back
Lumbar Spine MRI scan from the side

If we looked at a degenerate disc from the top down it would look a little like this:

diagram of a degenerative disc showing the irregular changes to the centre of the disc

Degenerative disc disease showing the ragged looking centre and the loss of integrity of the outer rings

Degenerative discs rarely come alone

Usually degenerative disc disease does not come alone, surrounding structures often show similar changes too.

Facet joints are the small joints where one vertebra overlaps the next. These joints develop changes on the joint surfaces and the cartilage, instead of being smooth, slippery and shiny becomes a bit scuffed and worn. This is called lumbar facet joint arthropathy.

 

Sometimes in response to these age changes in the discs and facet joints the body tries to generate more stability by growing more bone, unfortunately not always exactly where we want it. These bony growths are called osteophytes.

Osteophytes are nothing to worry about unless they are either irritating a nerve causing leg symptoms (such as those described in the nerve root irritation/sciatica section) or unless they are closing down the space in the spinal canal and restricting the spinal cord (spinal stenosis). In these instances surgery is the most likely treatment.

What causes this condition

The single most common cause is age. All of us age on the inside as much as the outside and these changes are common in all of us. There are some people who seem to develop this problem earlier in life and there are some theories about why that might happen.

From the research it seems as if some of these factors may have a role to play (Akmal et al. 2004; Matsui et al. 1998; Hangai et al. 2008)

  • Age
  • Genetics
  • Smoking
  • High Body Mass Index (BMI)
  • High Cholesterol

Why does it hurt?

Many people have degenerative disc disease and it doesn't hurt at all - they are unaware they have these changes until they have a scan or x-ray. Laboratory studies are beginning to shed some light on why some people have pain and not others.

1.Changes in nerve supply

It seems that the nerve supply in degenerative discs changes. A normal disc only has a small amount of innervation (nerve supply) at the outer edge of the annulus. In this condition it seems that the nerves grow inwards into the damaged disc and this may create painful signals.

2. Loss of disc height

As the discs get flatter and more dehydrated this height loss increases stresses and strain through the surrounding joints and ligaments of the low back which can be painful.

3. Loss of micro-stability

These changes in the normal function of the disc means it can't do its job of providing stability and cushioning as well as it did when it was younger. This does NOT mean you have an unstable spine that may fall apart. I am talking here about minute changes in the stability which means other structures have to work harder to keep things as normal as possible. If anything a spine with degenerative changes is stiffer and more solid than a younger, more supple spine.

4.How you think and feel about your pain

All pain is interpreted by the brain. Nerve signals indicating a problem are sent to your brain for processing. If your brain decides this is a significant threat to you then it will define those signals as pain, encouraging you to take some action.. If the signals are not seen as a threat your brain will ignore or dampen down the signals. (Read the pain section to gain a better understanding of this).

What this means is that if you are worried about your back, if you are feeling fearful and anxious then your pain may feel worse. Understanding the problem is a good way to stay calm and in control and that will help with your pain.

What is the Best Treatment for Lumbar Disc Disease?

Lots of my patients who come to see me with this problem are fearful of movement because they associate degenerative changes with instability and wearing away. It makes sense to them to keep still in order to prevent more wear and tear on their joints.

Actually, keeping still is the worse thing you can do for this, as movement is the thing that gives the joints nutrition and helps improve day to day activities.

You will not be able to change the fact that your discs have worn, and there is nothing you can do to cause the discs to become youthful again .However, there are plenty of things you can do to help ease any painful symptoms

Many different things influence whether we get back pain or not - and the actual physical findings on scan or X-Ray are actually less important then you might think.

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Lower back exercises to strengthen and stretch may be helpful

Physiotherapy treatment for this condition involves encouraging stiff areas of the spine to move more normally and using exercises to train the muscles that help to support and stabilise the lower back.

I have had some really good success stories with people who have felt very much better by managing the problem in this way.

Control your Pain

There are quite a few options here:

  • Think about using pain relieving medications - discuss with your doctor or pharmacist (pain makes it hard to move normally and be active but that is what you need to do to feel better)
  • Massage
  • Acupuncture
  • Heat Packs
  • TENS machines
Injections and Surgery

If stretching and exercising fails to help then the next step is usually to try a lumbar injections or a facet joint injection.

The final step is to discuss surgery as sometimes lumbar fusion surgery is tried to ease symptoms.

What Tests are Useful for Lumbar Degenerative Disc Disease?

X-rays and MRI scans are often arranged and they may help with the diagnosis.

It is really important to understand is that there is rarely any relationship between the changes seen on lumbar X-ray and MRI scans and symptoms.

It is also good to know that these changes are very common - even in people who don't have any lower back pain at all.

References

Akmal, M. et al., 2004. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine, 29(5), pp.568–75.

Hangai, M. et al., 2008. Factors associated with lumbar intervertebral disc degeneration in the elderly. The Spine Journal: Official Journal of the North American Spine Society, 8(5), pp.732–40.

Matsui, H. et al., 1998. Familial predisposition for lumbar degenerative disc disease. A case-control study. Spine, 23(9), pp.1029–34.

Waris, E. et al., 2007. Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine, 32(6), pp.681–4.

Zhao, C.-Q. et al., 2007. The cell biology of intervertebral disc aging and degeneration. Ageing Research Reviews, 6(3), pp.247–61.


Causes of lower back pain

Lower Back Pain Toolkit Home Page

February 1, 2013

 

 

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