Degenerative disc disease, the break down of the discs in the back, is a major cause of lower back pain in adults. Although older adults are affected most often, any adult can be affected. There are three predictable stages of degenerative disc disease. These stages develop slowly over a period of 20 to 30 years. The first stage is temporary dysfunction. The second stage is unstable. And the third stage in the cascade of events is stabilization.
What's really happening? Well, first the center of the disc (called the nucleus starts to break down. It loses its ability to absorb water and becomes dehydrated. This is the dysfunctional stage. Instability occurs as the outer covering of the disc develops fissures or tears.
The disc weakens and starts to collapse. Some say the disc is dying. In the final phase, the disc becomes stiff and fibrous. Although it's collapsed down and the nearby soft tissues get compressed, the overall segment stabilizes.
These various stages can be seen on MRI scans. When looking at imaging studies of the discs, healthy discs have a white center (nucleus), while the annulus (outer covering) seems dark. The nucleus will get darker as the disc degenerates until it becomes black, which means complete degeneration.
They call it black disc disease or disc desiccation. Desiccation just means dried out. Completely normal discs have a white center or nucleus. Those with severely degenerated discs show up with a black nucleus. And those in between are gray.
Reference:
Luke Madigan, MD, et al. Management of Symptomatic Lumbar Degenerative Disk Disease. In Journal of the American Academy of Orthopaedic Surgeons. February 2009. Vol. 17. No. 2. Pp. 102-111.
Treatment:
Generally speaking, the presentation and duration of symptoms in the cervical spine is similar to that of the lumbar spine. 60-80% of acute symptoms will resolve in 4-6 weeks with rest and other conservative measures. During this time, the spine should not be manipulated in any way. Muscle and sensory weakness or abnormality can be increased with any manipulation except longitudinal traction applied gently on the neck bones. Medications such as anti-inflammatories or a short course of low dose steroids can reduce the inflammation until the natural history of the problem resolves itself.
For patients who remain symptomatic beyond 6-8 weeks of conservative care, a decision about interventional treatment should be discussed between the patient and the physician. Increasing pain is a relative indication for surgery on the cervical spine. Muscle weakness or sensory changes which continue for 8-12 weeks or progressive neurological deficit are strong indications for surgical intervention. Signs of spinal cord compression such as balance or bowel and bladder problems are other strong indicators for aggressive intervention.
While Anterior Cervical Disectomy and Fusion remains the gold standard for treatment of cervical disc herniations and degenerative conditions of the cervical spine, the use of motion sparing techniques such as artificial disc placement are under investigation world wide.
In theory, an Artificial Cervical Disc is designed to maintain motion as a compared to the current treatment of fusing the spine. This could be beneficial in relieving symptoms and reducing stress on adjacent discs. Currently, we offer The Prestige Artificial Disc, and The Bryan Artificial Disc was recently approved by the FDA.
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