Disc Disease

The spine protects the spinal cords of nerves that travel down from the brain. The spine is made up of vertebrae (bones shaped like blocks) separated from one another by a disk. A disk is donut-shaped cushion. The center (the nucleus pulposus) of the disk is filled with a soft material, which is surrounded by a fibrous ring (the annulus fibrosus).

Facts to know about disc disease

Disc disorders encountered clinically include herniated nucleus pulposus (HNP), degenerative disc disease (DDD), and internal disc disruption (IDD).

HNP implies extension of disc material beyond the posterior margin of the vertebral body. The extruded material may cause inflammation and irritation around the region. DDD involves degenerative annular tears, loss of disc height, and nuclear degradation; which may cuase pressure and pain. IDD describes annular fissuring of the disc without external disc deformation.

In the presence of disc herniation or stenosis, radiculopathy from nerve root injury may occur, most commonly from narrowing of nerve canals; leading to sensory, motor, or reflex abnormalities in the affected nerve root distribution.

What are the causes of disc disease?

HNP results from repetitive stress or, rarely, from a single traumatic incident. Increased risk may accrue because of vibrational stress, heavy lifting, prolonged sedentary position, whiplash accidents, and frequent acceleration/deceleration.

DDD is part of natural aging, but it is also a consequence of poor nutrition, smoking, atherosclerosis, job-related activities, and genetics.

IDD can result from trauma, including whiplash, cervical flexion/rotation injury, and repetitive use.

Radiculopathy results from nerve root compression secondary to herniated disc material, stenosis, or chemical inflammation released from discs.

Symptoms of disc disease and radiculopathy

Symptoms of disc disease and radiculopathy include radiating pain into the limbs. This pain may be associated with numbness and tingling sensation in the limb, which may feel like it is "asleep". Additionally, weakness of the muscles may develop.

Diagnosis

All effective treatments are built upon accurate diagnosis. Your physician will use a combination of their expertise and state-of-the-art diagnostic technology to ensure a correct diagnosis. The diagnostic process includes:

Medical history. The doctor will ask you questions about your symptoms, their severity, and what treatments you have already tried.

Physical examination. You will be carefully examined for limitations of movement, problems with balance, and pain. During this exam, the doctor will also look for loss of reflexes, muscle weakness, loss of sensation or other signs of neurological injury.

Diagnostic tests. Most doctors start with x-rays, which allow us to rule out other problems such as tumors and infections. The films also allow us to see if there is any loss of disc space between the vertebrae. In most cases, a Magnetic Resonance Imaging or MRI will be ordered to further evaluate the spine and surrounding structures particularly in diagnosing nerve root compression. In some cases, a test called a discography may be done to confirm the diagnosis. This test involves injecting contrast dye into the affected disc (or discs) to create a clearer image.

Treatment options of disc disease

Conservative care (non-surgical) is recommended as the primary strategy and surgery is only considered if a concerted effort at conservative care fails to provide adequate pain relief or a patient’s daily activity has been significantly compromised. Conservative management involves the use of medications, physical therapy, and lifestyle changes. Steroid injections may relieve pain for a period of time.

When your back pain does not go away completely, or it gets more painful at times, learning to take care of your back at home and prevent repeat episodes of your back pain can help you avoid surgery. Here in MSPC, we will help you manage your pain.