Jeffrey Moore, MD
Orthopedic Surgeon

Understanding Degenerative Disc Disease

Degenerative disc disease (DDD) is not truly a “disease” in the traditional sense, but rather a term describing the natural wear and tear that occurs in the spinal discs as we age. Think of your spinal discs like jelly donuts between the bones (vertebrae) of your spine. They act as shock absorbers, allowing your spine to bend, twist, and flex comfortably. Over time, these discs can lose their flexibility, height, and ability to cushion the vertebrae effectively. This process is a normal part of aging for many people, though some experience more significant symptoms than others.

DDD can affect any part of the spine: the cervical (neck), thoracic (mid-back), or lumbar (lower back) regions. While imaging studies often show signs of disc degeneration in people who have no pain, for others, it can lead to chronic discomfort, stiffness, and reduced mobility.

How Our Discs Degenerate: The “Wear and Tear” Process

The human spine is a remarkable engineering feat, designed for both strength and flexibility. Its 33 vertebrae are separated by 23 intervertebral discs. Each disc has two main parts:

• Nucleus Pulposus: A gel-like inner core that provides cushioning and flexibility.
• Annulus Fibrosus: A tough, fibrous outer ring that holds the nucleus in place and helps distribute pressure.

As we age, a cascade of changes can occur within these discs:

• Loss of Water Content: The nucleus pulposus, composed largely of water, begins to dehydrate. This makes the disc less pliable and effective as a shock absorber. Imagine a plump grape slowly turning into a raisin – it loses its volume and springiness.
• Tears in the Annulus Fibrosus: The outer ring can develop small cracks or tears due to repeated stress, injury, or simply aging. These tears can sometimes be painful on their own, or they can allow the inner gel to bulge or leak out.
• Reduced Disc Height: As the disc loses water and integrity, it can flatten, bringing the vertebrae closer together. This can put increased pressure on the facet joints (small joints at the back of the spine) and the nerves exiting the spinal column.
• Bone Spurs (Osteophytes): In response to reduced disc height and increased friction, the body may attempt to stabilize the spine by growing small bony projections called osteophytes. These can sometimes impinge on nerves or the spinal cord.

While aging is the primary driver of DDD, other factors can accelerate the process or increase the likelihood of experiencing symptoms:

• Genetics: If your parents or close relatives experienced significant disc issues, you might be more predisposed.
• Obesity: Excess body weight places additional stress on the spinal discs, especially in the lumbar region.
• Physical Labor/Occupational Stress: Jobs involving heavy lifting, repetitive motions, or prolonged sitting can contribute to accelerated disc wear.
• Smoking: Nicotine can impair blood flow to the discs, hindering their ability to repair and maintain themselves.
• Trauma/Injury: Acute injuries to the spine can damage discs and lead to premature degeneration.
• Lack of Physical Activity: A sedentary lifestyle can weaken core muscles that support the spine, leading to increased stress on discs.

It’s important to reiterate that while these factors influence the process, DDD is a common and often benign part of growing older. Symptom development is what differentiates a “normal” aging spine from one requiring attention.

Recognize the Signs: Symptoms of Degenerative Disc Disease

The symptoms of DDD can vary widely from person to person. Some individuals with significant disc degeneration on imaging studies experience no pain, while others with seemingly minor changes report severe discomfort. The nature and intensity of symptoms often depend on which disc is affected, the extent of the degeneration, and whether nerves are being compressed.

Common symptoms include:

• Chronic Pain: This is often the most prominent symptom. It can range from a dull ache to sharp, shooting pain. The pain may worsen with certain activities, positions, or movements. For example, sitting for long periods might aggravate lower back pain, while neck pain could worsen with computer work.
• Pain that Worsens with Activity and Improves with Rest: This is a classic pattern. Activities that put pressure on the spine, like bending, twisting, or lifting, tend to increase pain. Lying down or stretching may provide some relief.
• Pain that Worsens with Weight-Bearing: Standing or walking for extended periods can sometimes exacerbate lower back pain.
• Intermittent Pain: The pain may come and go, with periods of remission followed by flare-ups, sometimes lasting days or weeks.
• Stiffness: Especially noticeable in the morning or after periods of inactivity.
• Muscle Spasms: Muscles around the affected disc may tighten involuntarily to protect the spine, leading to spasms and additional pain.
• Radiating Pain (Radiculopathy): If a degenerated disc causes a bulge or herniation that presses on a nerve root, pain can radiate into other areas of the body.
• Cervical DDD: Pain, numbness, or tingling can extend into the shoulders, arms, hands, and fingers.
• Lumbar DDD: Pain, numbness, or tingling can extend into the buttocks, legs, and feet (sciatica).
• Weakness: In severe cases of nerve compression, you might experience weakness in the muscles supplied by the affected nerve.
• Reduced Range of Motion: Difficulty bending, twisting, or extending your back or neck.

When to Seek Medical Attention (Red Flags)

While most DDD symptoms are not immediately life-threatening, certain signs warrant prompt medical evaluation. These “red flags” suggest potential nerve damage or other serious conditions requiring urgent assessment:

• Sudden onset of severe weakness in one or both legs.
• Loss of bladder or bowel control (urinary or fecal incontinence). This is a critical sign of cauda equina syndrome, a rare but serious condition.
• Progressive numbness or weakness in the legs.
• Difficulty walking or maintaining balance.
• Numbness in the “saddle area” (groin and inner thighs).
• Unexplained fever accompanying back pain.
• Significant pain that does not improve with rest or conservative measures.
• Pain following a traumatic injury (e.g., car accident, fall).

If you experience any of these red flags, it is crucial to seek immediate medical attention.

Pinpointing the Problem: Diagnosis of Degenerative Disc Disease

A proper diagnosis of degenerative disc disease involves a comprehensive approach, combining your medical history, a physical examination, and advanced imaging studies. Dr. Moore and his team will take the time to understand your unique pain experience.

Your Medical History

This is the first and often most crucial step. You will be asked about:

• Your symptoms: When did they start? What do they feel like? Where do they hurt? Do they radiate? What makes them better or worse?
• Your daily activities and lifestyle: What sort of work do you do? Are you physically active? Do you have any hobbies that might contribute to your pain?
• Past injuries or surgeries: Have you had any previous back or neck problems?
• Other medical conditions: Do you have any other health issues that might be related or influence treatment?
• Medications you are currently taking.

Be prepared to describe your pain as clearly as possible. This information allows the doctor to narrow down potential causes.

Physical Examination

During the physical exam, Dr. Moore will:

• Observe your posture and gait (how you walk).
• Palpate (feel) your spine: Checking for tenderness, muscle spasms, or abnormalities.
• Assess your range of motion: Asking you to bend, twist, and extend your neck and back to identify restrictions or pain points.
• Perform neurological tests: This involves checking your reflexes, muscle strength, and sensation (light touch, pinprick) in your arms and legs. These tests help determine if nerves are being compressed and, if so, which ones.

Imaging Studies

While symptoms are paramount, imaging studies provide visual confirmation of the extent and location of disc degeneration.

• X-rays: X-rays are excellent for visualizing bone structures. They can show:
• Reduced disc height: Indicating a flattened disc.
• Bone spurs (osteophytes): Bony growths that can develop around degenerated discs.
• Spinal alignment issues: Such as scoliosis (a curve in the spine).
• While X-rays don’t directly show discs (which are soft tissue), they provide important clues about the overall health of the spinal bones and spacing between vertebrae. They are often the first imaging study ordered.

• MRI (Magnetic Resonance Imaging): MRI is considered the “gold standard” for evaluating soft tissues like intervertebral discs, nerves, and the spinal cord. It provides detailed images that can reveal:
• Disc dehydration: Degenerated discs appear darker on MRI scans due to their reduced water content.
• Bulging or herniated discs: Showing if the disc is protruding and potentially pressing on nerves.
• Spinal stenosis: Narrowing of the spinal canal or nerve pathways.
• Nerve compression: Clearly visualizing if nerve roots are being impinged.
• Inflammation or other soft tissue abnormalities.

MRI is invaluable for confirming the diagnosis, determining the severity, and planning the most appropriate treatment.

• CT Scan (Computed Tomography): A CT scan is sometimes used when an MRI is not possible or to provide more detail about bony structures. It can show bone spurs and spinal canal narrowing more clearly than X-rays. It’s also useful for pre-surgical planning.

It’s common for imaging studies to show signs of disc degeneration even in people who have no pain. This underscores the importance of correlating imaging findings with your actual symptoms and physical examination. Dr. Moore reviews your images carefully to understand the whole picture.

Paths to Relief: Treatment Options for Degenerative Disc Disease

The goal of treating symptomatic degenerative disc disease is to relieve pain, improve function, and enhance your quality of life. Treatment typically begins with the most conservative approaches and progresses to more invasive options only if necessary. Dr. Moore emphasizes a personalized approach, tailored to your specific condition and needs.

Conservative Management (Non-Surgical)

For the vast majority of people, initial treatment focuses on non-surgical methods. These aim to reduce pain, improve strength, and promote healing within the spine.

• Rest and Activity Modification: In acute flare-ups, a short period of rest (1-2 days) might be helpful, but prolonged bed rest is generally not recommended. Modifying activities that aggravate your pain is crucial. This might mean temporarily avoiding heavy lifting, certain sports, or prolonged static positions.
• Pain Medications:
• Over-the-counter (OTC) pain relievers: Acetaminophen (Tylenol) or NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help manage pain and inflammation.
• Prescription medications: For more severe pain, your doctor might prescribe stronger NSAIDs, muscle relaxants to alleviate spasms, or, in some cases, a short course of oral corticosteroids to reduce inflammation. Opioids are generally reserved for very short-term use due to their addictive potential.
• Physical Therapy: This is a cornerstone of conservative treatment. A physical therapist will design a program to:
• Strengthen core muscles: A strong core provides better support for your spine.
• Improve flexibility: Stretching exercises can reduce stiffness and improve range of motion.
• Enhance posture: Learning proper body mechanics can reduce stress on your discs.
• Teach pain management strategies: Ergonomic adjustments for work and home.
• Injections:
• Epidural Steroid Injections (ESIs): These involve injecting a corticosteroid (a powerful anti-inflammatory medication) and a local anesthetic into the epidural space around the spinal nerves. ESIs can provide temporary pain relief by reducing inflammation around compressed nerves. They are primarily diagnostic and therapeutic for nerve root compression (radiculopathy).
• Facet Joint Injections: If facet joint arthritis (secondary to disc degeneration) is the primary pain source, injections into these small joints can offer relief.
• Nerve Blocks: Can be used diagnostically to pinpoint the source of pain or therapeutically to calm irritated nerves.
• Chiropractic Care or Osteopathic Manipulation: Some individuals find relief from manual adjustments and manipulation aimed at improving spinal alignment and reducing muscle tension. It’s important to choose a qualified practitioner.
• Heat and Cold Therapy: Applying heat (like a heating pad or warm bath) can relax muscles and improve blood flow, while cold packs can reduce inflammation and numb pain.
• Lifestyle Modifications:
• Weight management: Losing excess weight significantly reduces stress on the spine.
• Smoking cessation: Quitting smoking improves disc health and overall healing.
• Regular exercise: Low-impact activities like swimming, cycling, or walking can strengthen muscles and improve spinal health.

Surgical Interventions

Spine surgery is typically considered only after a substantial trial (several weeks to months, depending on the severity) of conservative treatment has failed to provide adequate relief, or if there are clear signs of progressive neurological deficits (e.g., worsening weakness, numbness, or bowel/bladder issues). Dr. Moore specializes in advanced spinal surgery techniques.

The primary goals of surgery for DDD are:

1. Decompression: Relieving pressure on nerves or the spinal cord.
2. Stabilization: Fusing vertebrae together or replacing a disc to limit painful motion.

Our available surgical options include:

• Minimally Invasive Spine Surgery (MISS): Dr. Moore employs advanced MISS techniques to reduce collateral damage to muscle and soft tissues compared to traditional open surgery. This often translates to less pain, smaller incisions, faster recovery times, and reduced risk of complications.
• Prone TransPsoas (PTP) Approach: This is an innovative minimally invasive technique often used for lumbar fusions. It involves accessing the spine from the side, through the psoas muscle, while the patient is lying prone (on their stomach). This allows for placement of a large interbody cage, restoring disc height and stability, while potentially minimizing disruption to posterior spinal muscles and nerves.
• Ultrasonic Decompressions: Rather than using traditional high-speed drills, ultrasonic surgical tools utilize high-frequency vibrations to precisely remove bone (e.g., bone spurs) or disc material, often with less thermal damage to surrounding tissues and reduced risk of injury to crucial structures like nerves.

• Decompression Procedures:
• Laminectomy/Laminotomy: Removal of part or all of the lamina (the bony arch on the back of the vertebra) to create more space for nerves and the spinal cord, often used for spinal stenosis.
• Discectomy: Removal of the damaged portion of a herniated disc that is pressing on a nerve. This can be performed minimally invasively.

• Fusion Surgery (Arthrodesis): If spinal instability is causing significant pain, fusion surgery may be recommended. This involves permanently joining two or more vertebrae together to eliminate motion between them. Bone graft material (from the patient, a donor, or synthetic) is used, often augmented with screws, rods, or plates, to promote solid bony healing. Fusion can be performed in the:
• Cervical Spine: For neck pain, arm pain, or instability.
• Thoracic Spine: Less common, but sometimes needed for trauma or severe deformity.
• Lumbar Spine: For lower back pain, leg pain, or instability.

• Artificial Disc Replacement (Arthroplasty): For selected patients with single-level degenerative disc disease in the neck or lower back, disc replacement can be an alternative to fusion. This involves removing the damaged disc and replacing it with an artificial disc prosthesis designed to preserve motion at that spinal level. This can potentially reduce the risk of adjacent segment degeneration compared to fusion.

• Scoliosis Correction: If DDD contributes to the progression of adult degenerative scoliosis (a sideways curvature of the spine), surgical correction may be necessary to correct the deformity, decompress nerves, and stabilize the spine. Our expertise allows for complex scoliosis corrections, often utilizing minimally invasive principles where appropriate.

• Trauma Follow-Up and Reconstruction: In cases where DDD is exacerbated or complicated by spinal trauma, Dr. Moore provides follow-up care and reconstructive surgery to address instability, persistent pain, or neurological deficits resulting from the injury.

The decision to proceed with surgery is a serious one, and Dr. Moore will thoroughly discuss all options, potential benefits, and risks with you. We believe in empowering you with complete information to make the best decision for your health.

Frequently Asked Questions About Degenerative Disc Disease

Q: Is DDD a progressive condition?

A: Yes, it is typically progressive, meaning the degeneration often continues over time. However, the symptoms may not necessarily worsen or may even improve with treatment. Many people learn to manage their condition effectively.

Q: Can exercise make DDD worse?

A: Not necessarily. In fact, appropriate exercises are a cornerstone of managing DDD. High-impact or improper exercises can sometimes aggravate symptoms, but a tailored program from a physical therapist can strengthen your back, improve flexibility, and often reduce pain.

Q: Will an MRI show if I have DDD?

A: An MRI can show clear signs of disc degeneration, such as dehydration, reduced disc height, and bulging or herniated discs. However, it’s important to remember that many people have signs of DDD on MRI without experiencing any pain. The findings need to be correlated with your symptoms and physical exam.

Q: Can DDD be cured?

A: Degenerative disc disease is a natural aging process, so it cannot be “cured” in the sense of reversing the changes in the discs. However, the symptoms of DDD can be effectively managed and significantly reduced, often to the point where they no longer interfere with daily life. Treatment focuses on managing pain and improving function.

Q: What is the most important thing I can do for my back if I have DDD?

A: Maintaining a healthy weight, staying active with appropriate exercises, avoiding smoking, and practicing good posture are among the most important things you can do to support your spinal health and manage DDD.

Your Path to Relief Starts Here

If you are experiencing persistent back or neck pain, stiffness, or radiating symptoms that you suspect might be related to degenerative disc disease, it is important to see a qualified spine specialist. Dr. Jeffrey Moore is a fellowship-trained Orthopedic Spine Surgeon committed to providing compassionate, evidence-based care. We serve the OKC metro area, including Norman, Edmond, and Yukon.

Don’t let pain control your life. Take the first step towards understanding your condition and exploring your options for relief.

Contact Us Today:

Call our office at (405) 645-5475 to schedule an appointment.

You can also book online through our website.

We offer a FREE MRI review and second opinion, so you can gain clarity and confidence in your treatment plan.

CALL (405) 645-5475

FAQs

What is degenerative disc disease?

Degenerative disc disease is a condition where the intervertebral discs in the spine deteriorate or break down over time, leading to pain, reduced flexibility, and other symptoms.

What causes degenerative disc disease?

The primary cause is the natural aging process, which leads to the loss of water content and elasticity in the spinal discs. Other factors include injury, repetitive stress, genetics, and lifestyle choices such as smoking.

What are the common symptoms of degenerative disc disease?

Symptoms often include chronic back or neck pain, stiffness, numbness or tingling in the limbs, and sometimes weakness. Pain may worsen with certain movements or prolonged sitting or standing.

How is degenerative disc disease diagnosed?

Diagnosis typically involves a physical examination, review of medical history, and imaging tests such as X-rays, MRI, or CT scans to assess the condition of the spinal discs.

When should I seek medical help for degenerative disc disease?

You should consult a healthcare professional if you experience persistent or worsening back or neck pain, numbness, weakness, or loss of bladder or bowel control, as these may indicate more serious complications.

What treatment options are available for degenerative disc disease?

Treatment can include physical therapy, pain medications, lifestyle modifications, injections, and in severe cases, surgical interventions to relieve pain and improve function.

Can degenerative disc disease be prevented?

While aging cannot be prevented, maintaining good posture, regular exercise, a healthy weight, and avoiding smoking can help reduce the risk or slow the progression of degenerative disc disease.

Is degenerative disc disease a progressive condition?

Yes, degenerative disc disease can progress over time, but the rate and severity vary among individuals. Some people may experience mild symptoms, while others may have significant pain and disability.

Can degenerative disc disease cause permanent damage?

In some cases, if left untreated, it can lead to nerve damage or spinal instability, which may cause permanent issues. Early diagnosis and treatment are important to prevent complications.

Are there lifestyle changes that can help manage degenerative disc disease?

Yes, regular low-impact exercise, maintaining a healthy weight, practicing good posture, and avoiding activities that strain the spine can help manage symptoms and improve quality of life.