Degenerative Disc Disease | Treatment and Prevention

The good news is many treatments can provide relief by easing inflammation and pressure on delicate nerves. This guide will explain both non-surgical treatments and surgery options for managing Degenerative Disc Disease (DDD).

Understanding Degenerative Disc Disease

Your spine allows flexibility thanks to discs that lie between each spinal bone (vertebra). Think of discs as jelly doughnuts – they have a thick outer layer with a soft inside. These shock absorbers allow your back to move while protecting vertebrae.

As part of normal aging, discs lose hydration and their cushy insides start to collapse. Genetics, injury, poor posture, heavy lifting, smoking cigarettes, and carrying excess weight also accelerate disc damage. When discs shrink down, chemicals inside can leak out and irritate nearby nerves. This causes painful inflammation and pressure on nerves.

DDD symptoms often come and go but tend to worsen over time. Most people experience stiffness and aching localized to their lower back. The pain usually gets worse when sitting, lifting objects, or bending forward. Some people also get numb, tingly feelings that shoot down their legs due to trapped nerves in their spine.

While DDD itself cannot be reversed, many treatment options exist to relieve discomfort and get you moving comfortably again. Your doctor will recommend starting simple before trying more intense procedures.

Medications

Doctors often first recommend anti-inflammatory medications, both over-the-counter and prescription varieties. These work by reducing swelling around irritated nerves. Common options include:

NSAIDs: Familiar NSAID pills like Advil, Motrin, Aleve, and aspirin available at any pharmacy ease inflammation and pain when taken regularly. They come with minimal side effects like stomach upset or ulcers when used carefully.

Steroids: Powerful prescription steroid pills or injections directly into your spine dramatically reduce swelling. A few rounds of high-dose steroids offer lasting relief for many DDD patients.

Muscle Relaxers: Muscle spasms and cramping from swollen nerves rubbing make DDD pain worse. Muscle relaxant pills like cyclobenzaprine provide relief by easing tightened muscles for several weeks while other treatments start working.

Lifestyle Changes

Simple daily adjustments in how you care for your back promotes healing and prevents extra strain that could speed up disc damage. Smart lifestyle modifications include:

• Achieving an optimal body weight to limit mechanical stress on precious discs
• Avoiding habits like smoking that restrict blood flow essential for disc health
• Using excellent posture when sitting and standing to maintain the spine’s natural alignment
• Making ergonomic changes like supportive chair cushions and firm mattresses
• Learning proper lifting techniques to rely more on leg strength versus the flexibility of your back

Building core and glute muscles through careful exercise like Pilates further stabilizes and protects the spine. Even without access to gyms or special equipment, simple choices grant you control over managing chronic back discomfort associated with DDD.

Physical Therapy

Doctors frequently refer patients with stubborn DDD pain to work closely with a physical therapist (PT). These rehabilitation experts create customized exercise routines that gently improve flexibility and strength specific to your needs. Benefits of PT for back health include:

• Targeted stretching that increases range of motion and reduces tenderness
• Low-impact cardio training such as walking, swimming or biking that enhances overall fitness needed for daily tasks
• Balance training which improves stability and prevents falls that could further injure fragile spines
• Massage therapy easing muscle tightness alongside nerve tension
• Gentle joint mobilization and soft tissue release techniques
• Heat/cold modalities alternating Ice and heat packs relieve swelling and discomfort
• Instruction on ideal sleeping positions as well as proper bending and lifting mechanics

Under guidance from a perceptive PT, at least twice weekly sessions greatly accelerate recovery. Healthy movement patterns prevent against disability and job loss sometimes associated with severe DDD.

Steroid Injections

If you struggle getting pain relief from pills, lifestyle measures, and PT, your doctor may recommend injecting potent steroids right around inflamed spinal nerves. Commonly performed injection procedures include:

Epidural Steroid Injections: The epidural space surrounds the bag of fluid protecting your spinal cord and nerves. Injecting steroids into this narrow canal washes anti-inflammatory effects over trapped nerves suffering from disc-related swelling. Many patients gain benefit lasting a month or longer from just 1-3 injections.

Facet Joint Injections: Arthritic degeneration of the facet joints connecting vertebrae causes localized stiffness and pain, especially with twisting motions. Steroids decrease irritation when injected directly inside these small spinal joints.

Under brief anesthesia, steroid injections take less than 30 minutes in your doctor’s office. Over half of patients get significant relief of leg and back pain from a single injection. If symptoms recur, treatments can be repeated up to 3-4 times yearly.

Radiofrequency Ablation

Ablation procedures deliberately interrupt pain signals being falsely generated from irritated spinal nerves. An injection needle allows doctors to target overactive nerves. Tools utilizing gentle thermal energy are then deployed to calm these sensitive nerves.

Radiofrequency ablation (RFA) generates safe radio waves creating heat that disrupts nerve communications. Patients remain comfortable under light sedation as probes heated to 60-80°C bathe damaged nerves for 60-90 seconds. The procedure temporarily switches off nerves which grow back over 6-18 months. By then, other anti-inflammatory treatments have hopefully kicked in to maintain pain relief.

Surgery

Only after thoroughly trying medication combinations, steroid injections, physical therapy, and lifestyle changes over at least 6 months does surgical treatment become appropriate for DDD. If non-surgical treatments fail while pain progressively worsens and clearly traces to physical spinal abnormalities on imaging, back surgery may help reduce disability.

Common reasons spine specialists ultimately recommend operation include:

• Conservative treatment measures ineffective after an adequate trial
• Persistent pain severely limiting normal daily functions
• Nerve damage numbness/weakness spreading indicating additional discs herniating

There are 3 main surgical options for unstable, painful segments of a damaged spine:

Decompression Surgery

Back surgery starts with “clearing space” and removing problematic disc fragments or bony growths directly squeezing delicate nerves emerging from the spinal cord. This decompression opens up room for nerves to heal and prevents further irritation. Surgeons access the spine either from the back or front depending on location. Common decompression operations include:

Laminectomy: Removing portions of thickened bone and ligament overgrowth (the lamina) takes pressure off nervous structures. This works well for spinal stenosis.

Foraminotomy: Enlarging tiny openings (foramina) where spinal nerves exit enlarges space for irritated nerves to exit without rubbing on bone.

Recovery after decompression surgery focuses on gradually increasing activity over 2 months. Most patients receive pain relief faster than spinal fusion procedures.

Spinal Fusion

When DDD leads to overt spine instability, fusion provides permanent stabilization. After removing the disc, surgeons affix bones with supportive hardware like rods until they grow together. Common types of spinal fusion operations include:

Anterior cervical disc fusion (ACDF) for neck segments approaches through small neck incisions. This stabilizes movement between vertebrae leading to arm pain or numbness.

Posterior lumbar interbody fusion (PLIF) for lower spine instability goes through the back and leaves patients with less movement but reduced chronic pain. Surgeons may later remove hardware once complete bone fusion matures over 9-12 months.

Disc Replacement

Instead of fusion which eliminates movement, artificial discs preserve flexibility. Made of metal and plastic, disc prosthetics have two main components:

• Endplates attaching above and below to vertebrae. These promote bone cell integration for stability.
• A mobile core that pivots as you move just like a normal cushioning disc

The ball and socket design successfully reduces abnormal spinal strain. After age 65, fusion typically works better since older bones integrate implants slower.

Which type of back surgery works best depends on many individual factors – location of damaged discs, overall health, smoking status, spine stability, surgeon judgment, and more. Make sure to carefully consider pros vs cons of each option. While not reversible, spine operations provide most patients significant and lasting pain decrease.

Conclusion

Living with constant back pain from degenerative disc problems can get discouraging fast. Using a stepwise approach starting with safer options not involving needles or scalpels makes sense before considering invasive measures. Surgery should not enter the equation until completing other treatments over months without success. Patience allows time for areas of swelling and nerve inflammation to potentially subside.

Luckily with so many medication and therapy choices now available, over 85% of DDD patients discover at least some relief from chronic discomfort. Work closely with your medical team to customize the combination that grants you the support needed to stay active while avoiding riskier interventions. Each small victory getting back to normal activities makes the effort worthwhile!