Degenerative Disc Disease (DDD): Remedies For Lower Back Osteoarthritis That Provide Relief
Does your X-rays or MRI show Degenerative Disc Disease DDD?
Do you have radiating pain or weakness in your leg from degenerative disc disease?
Does forward movement aggravate your pain while extension relieves your pain?
In this issue of Bodi Empowerment I’ll go over the causes of degenerative disc disease DDD, why you are getting pain, MRI and X-rays views of DDD and finally treatments.
Treatments for degenerative disc disease include conservative therapy, disectomy, disc fusion, disc replacement ( disc arthroplasty ).
Your doctor told you that you have degenerative disc disease DDD and even showed you the X-rays or MRI so it must be causing your pain right? We now know better, research has proven that the degree of degenerative disease has absolutely nothing to do with pain. .
You have to be careful that your doctor isn’t diagnosing you based on X-rays and MRI and instead carefully looking at your history and examination. The X-rays and MRI are used to confirm a doctor’s diganosis, not to make a diagnosis.
You can have severe degenerative disc disease and have mild pain and stiffness. Mean while your neighbour can have mild degenerative disc disease and have severe pain.
So, What Is Degenerative Disc Disease
Degenerative Disc Disease is the wearing or the breaking down of your disc found between your vertebra.The disc eventually becomes visibly thinner with imaging such as X-rays or MRI. It’s sometimes called osteoarthritis of the disc, or spondylosis. Either way your health practitioner is still talking about the same thing.
For example spondylosis of the L45 disc is still degenerative disc disease. Osteoarthritis at the L5S1 disc is still degenerative disc disease.
Why Is My Disc Degenerating?
Everybody’s disc degenerates. If you inherited certain genes you will have earlier degenerative disc disease. If not you will likely find the visible beginnings of DDD by the time you are forty years old.
Just like wrinkles, some of you start to get wrinkles earlier than others but everyone eventually gets a lot of wrinkles with enough time. Similarly, some people start to show the signs of DDD in their twenties, others much later but eventually everybody gets degenerative disc disease. It’s a part of ageing.
You need to understand the three basic parts of the disc. The nucleus, annulus and end plate. The nucleus and annulus is akin to an flat onion with jelly in it. The jelly is the nucleus and the onion part is the annulus with many circular layers. Above and below is an endplate. The end plate is like a fine wire mesh on top and the bottom of the disc.
The disc gets it’s life giving blood, from tiny blood vessels that go through this wire mesh (end plate) and stop at the disc. These blood vessels comes from the vertebrae above and the vertebrae below through the mesh (end plate) that attaches to the disc. No blood vessels exist in the actual disc the nutrients have to flow into the center of the disc by diffusing through the jelly (nucleus) and the onion (annulus).
By 7 years of age, these tiny blood vessels that used to feed the disc no longer penetrate the end plate.[3-5] Which means your discs aren’t getting as much nutrition as they used to. By the time you are 20 years of age the blood vessels no longer exist.
This means you are starting the process of degenerative disc disease at 20 years of age, some researchers say in the first 10 years of life, so that you can see visible changes in many people’s X-rays by the time they are 40 years of age.
Your disc is under a lot of pressure from the inside so it can hold up the weight of your body. So picture the annulus and nucleus with substantial pressure on the inside like a balloon with lots of water in it. As you age the decreasing blood flow and lack of nutrients and oxygen makes the cells in the disc start to die. With less cells to produce water retaining molecules the water content of your disc decreases. With less water the pressure in your disc decreases.[6-7]
With your disc deflating like a balloon the pressure on the disc gets shifted from the center of the disc to the back of your disc (annulus) and the joints at the back (facets). The shift in pressure eventually causes fissures in the annulus and osteoarthritis in the joints (facets)
Stage #1 Disc Bulge
- After a few years to a few decades of pressure shifted toward the back the disc a fissure breaks the many layers of the annulus so that only a few layers of the annulus left to hold the disc back.
- This allows the nucleus (jelly) to push through annulus (onion) closer to the edge of the annulus. This is a Disc Bulge ie. nucleus has pushed out toward the edge of the annulus.
Stage #2 Disc Prolapse
- A disc protrusion is like a disc bulge that comes out even more in one focused spot. The disc pushes out as if you had your finger inside a balloon and pushed out.
- A disc protrusion is when the nucleus has pushed through so many layers of the annulus that only one or two layers of the annulus (onion) and a PLL ligament are holding back the nucleus.
- Good news: Severely degenerated discs do not prolapse as there isn’t enough pressure within the disc it self for this to happen.
Stage #3 Disc Extrusion
- A disc extrusion is when the nucleus breaks through the final layers of the annulus and the PLL ligament and pinches on the nerve (spinal nerve).
- In most cases your lower back pain is painful but your sciatica is much more worse than your lower back pain.
See Also: Best Exercises For Your Herniated Disc
Vertical Disc Herniation (Smorl’s Node)
- Compression of the spine like lifting very heavy weights, and falling onto your buttock will cause Vertical Disc Herniations in the young.
- When you are young (20 years or under) the annulus is still intact so the weak point becomes the end plate (wire mesh). When you fall down and compress your spine severely the annulus is strong enough to withstand tremendous pressure but your weak link is the end plate. The pressure breaks the end plate pushing the nucleus (jelly) into the vertebra below.
- When the nucleus herniates (pushes into) into the vertebra there is more space for the nucleus (jelly) so it’s like deflating a balloon.
- The decrease disc pressure from disc causes a shift of pressure toward the back of the annulus and the joints (facets) just like a normal disc herniation.
- A Schmorl’s node can be seen on X-ray when the nucleus which has herniated (pushed) into the disc and later on calcifies.
Why Is My DDD Painful?
Your disc has hardly any pain fibers The only pain (nerve) fibers are on the back outer 1-3 mm of the annulus (onion) and most often aren’t activated unless your disc is injured.
Your disc degenerates without any pain until the fissures in the disc reaches the outer annulus where the nerve is. When this happens you likely have pain.
Your disc can than progress further to develop a more narrowed disc, fissures in the annulus (onion) and eventually form a disc bulge which often causes pain most of the time.
End plate (wire mesh) collapse called a Schmorl’s node is often related to pain, as that pushes your nucleus (jelly) into the vertebra which has many pain fibers.
If your disc has substantial degenerative disc disease, nerve (pain) fibers actually start to grow into the annulus (onion) and eventually into the nucleus (jelly) which can cause you lots of pain.
Sometimes even disc herniations have nerves grow into them as well, causing pain.
Injuries to a disc never heal like a bone can heal after a fracture.
Imaging: How To See DDD
You can see degenerative disc disease on X-rays, CT (CAT) scans and MRI. The most important factors are disc narrowing (smaller), ostoephytes (spurs of bone) and disc bulging (seen only on MRI and CT scans)
Often when seen together the radiologist will use the term spondylosis. Most of the time though it may be used to refer to a narrowed disc alone or the presence of multiple osteophytes.
#2 Magnetic Resonance Imaging (MRI)
An Magnetic Resonance Imaging (MRI) is the most sensitive tool we have to look at degenerative disc disease. You are looking for disc narrowing, bony spurs called osteophytes, bulging discs and how well the disc is functioning.
MRI’s have two main settings T1 and T2. The T2 setting shows any tissue that has lots of water in it to show up bright white. The brighter the tissue the more water there is in the tissue.
Normally your disc and spinal cord have a lot of water in it so will show up bright white especially in the nucleus (jelly). As your disc ages, the disc starts to lose water and eventually starts breaking down. The more water you lose from the disc the blacker the disc looks and the more your disc has degenerated.
When your disc has substantial degenerative disc disease your disc will no longer look white on a T2 MRI. It will look black since the water has been completely sucked out the disc. This is called dessication of your disc.
Discography involves injections to try and give you pain in the disc that you think is causing you pain. It’s for people that haven’t responded to non-surgical care and is usually used for planning lumbar fusion surgery.
If your doctor tells you that you need to have a discography you should have serious concerns. First if you don’t get the surgery it may accelerate disc degeneration and 25% of people are found to have a disc problem when they actually don’t.[9-10] That’s a huge rate of mistakes.
Remember they are using discography to decide whether they are going to do surgery.
Prevent Degenerative Disc Disease
Your mom and dad are the main cause. In other words genetics. Smoking and manual labour are not as important factors for Degenerative Disc Disease. Your parents played the most meaningful part.
The genes that you inherited influence the size, shape and make-up of the vertebrae and disc but also how resilient your disc is.
Studies show that if there is a family history of DDD in patients who are diagnosed with a herniated disc before age 21. (Remember you end up with disc herniations as a part of the DDD process)
The minor factors which puts you at risk for degenerative disc disease are frequent bending and twisting, and whole body vibration,  smoking from nicotine and impaired blood flow to the disc [12-15] and association of plaques in the arteries called atherosclerosis in the main artery in the lower back 
Heavy lifting is associated with disc prolapse but not other areas of degenerative disc disease
The golden rule is always try non-surgical care first. Spinal manipulation by a chiropractor, McKenzie approach and lower back stabilization exercises have been shown to relieve pain.[17-18]
Traction and spinal decompression has not been shown to be effective for treating degenerative disc disease.
#1 Fusion Surgery (Arthrodesis)
Spinal fusion surgery involves removing the nucleus and most of the annulus. Bone from the pelvis is transplanted where your disc was so that the two vertebrae become one.
Sometimes spinal fusion surgery is effective for treatment of pain but increases the rate of degeneration in the adjacent vertebrae, usually significantly within 10 years after the surgery.[19-21]
If your surgeon isn’t telling you this that is a yellow flag. Your surgeon should freely tell you all the pros and cons of fusion surgery.
Danger: Bone Morphogenetic Protein (BMP) is sometimes used instead of taking some of your own hip bone to fill in the space vertebrae for fusion. Instead they use BMP as a bone graft substitute.
In 2008, the FDA published a public health notification about potentially life-threatening complications associated with use of BMP in cervical spine fusion .
In Europe this is the gold standard for disc replacement. What’s troubling is that two studies found that there was no advantage of fusion over exercise therapy and cognitive therapy in the short and long term.
#2 Total Disc Replacement
Total Disc Replacement is a type of surgery where you take out the offending disc and replace it with an artificial disc. There are concerns about the long-term durability of polyethylene.[22-23] Claims about prevention of adjacent veretebra wear and tear are not clear yet.
Several studies also report that there is complete loss of motion at the operated level from the bones fusing the artificial segment on its own or need for a second surgery. Furthermore not one study demonstrates that artificial disc reduces degeneration at vertebrae adjacent to it.
Deaths have occured due to blood clots or bleeding from blood vessels being injured following the surgery.
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