To explain the spine condition known as degenerative disc disease, orthopaedic spine surgeon Jerry Robinson, MD finds it easier to talk about knees.
“People have a good grasp on arthritis in the knee,” he says. “They understand wear and tear in knee cartilage. The same thing happens in your back,” says Dr. Robinson.
He uses that analogy to try to make people less afraid. “Too often, the spine seems like a scary black box. But it doesn’t have to be that way,” he says. “Just like not everyone needs a knee replacement, not everyone needs spine surgery. There is a lot we can do between doing nothing and having surgery.”
What Is Degenerative Disc Disease?
The vertebrae of your spine are separated by discs which allow your spine to flex, bend, and twist. They have a firm outer layer and soft, jelly-like core.
Just as cartilage wears out and can tear, your discs can also experience wear and tear. When that happens, it’s called degenerative disc disease.
“Degenerative in this sense is defined as the changes the spine and its supportive structures go through over time as a natural part of aging,” says Bryan Bolinger, DO, a neurosurgeon who works with Dr. Robinson.
“Despite its name, it’s not really a disease,” he adds. “Everyone will have degeneration of the discs to some degree, likely beginning in their teenage years. A recent study published in the American Journal of Neuroradiology demonstrated that signs of disc degeneration and bulging discs can be found in as many as 37% and 30% of healthy 20-year-old patients who are living life without back pain.”
Dr. Bolinger says that mechanical factors in the way people use or abuse their backs can accelerate the degeneration of the spine. So, x-rays may show signs of degeneration long before the person starts to feel pain or have any issues. “Imaging the adult spine will almost always show these same degenerative findings,” he says. “Some of these findings may be relevant. Others may not. We ‘re here to help patients sort through all of this.
“It’s not really about how your films look,” adds Dr. Bolinger, who works with Dr. Robinson. “It’s how you feel that’s important.”
Dr. Robinson concurs. “If I randomly gave MRIs to everyone over 25, they would all have some degree of disc wear and tear,” he says. “The hard part is knowing if the wear and tear is age-related or if something more serious is wrong.”
Symptoms of Degenerative Disc Disease
As we age, our discs break down, or degenerate. At times, these changes can lead to pain. For example, if it’s harder to do a yoga pose than it used to be, that may be normal. If you’re in terrible pain while sitting at your desk at work, however, there could be an underlying issue.
“With disc problems, there is often an inciting incident. A patient will say, ‘I picked up a heavy box and suddenly felt pain ripple through my spine,'” Dr. Robinson says. “When someone knows exactly what happened, it makes my job easier. But for many people, it’s chronic pain that comes and goes for 10 years.”
Some common symptoms of degenerative disc disease include:
- Neck or back pain.
- Numbness or tingling.
- Pain in the hip, buttocks, legs, or feet.
- Pain in the shoulders, arms, or fingers.
- Pain that worsens when you move, such as when you bend over, reach up, or twist.
Joint pain usually hurts when you move; but with disc issues, the pain often is worse when you are sitting. Dr. Robinson says he’ll ask people to rate their pain on a scale of one to 10, but it’s not a perfect method.
“People tolerate different amounts of pain,” he says. “But if you aren’t tolerating the pain or don’t want to tolerate it, you should talk to your health care provider.”
The Team Approach to Degenerative Disc Disease
At UPMC Spine Care, a team approach is used to ensure each patient gets the right treatment – whether that is a surgery or more conservative tactics.
In fact, roughly 80% to 95% of people with disc problems improve after three months of conservative care alone. Conservative measures will always be considered before moving forward with an elective spinal operation.
“The spine specialists here work very closely with one another,” says Dr. Bolinger. “We discuss cases together and often send our patients to each other for second opinions. If conservative treatments fail and surgery is recommended, we often assist each other in surgeries which we deem inherently more complex.”
Preventing Degenerative Disc Disease
Degenerative disc disease represents the natural aging of the spine which can be accelerated depending upon how we use and abuse it. There may also be a genetic factor which influences disc degeneration.
Ultimately, no one is totally immune to degenerative disc disease. But Dr. Robinson suggests some things you can do to lessen your risk:
- Be intentional in small movements. Pay attention to all those little movements throughout the day. Try not to plop on the couch, suddenly twist to grab something, or bend too quickly when getting dressed.
- Bend your knees and lift with your legs. Avoid bending over or stooping when lifting objects — including light ones. Over time, lifting even light things improperly will cause unnecessary wear and tear.
- Don’t smoke. There is a clear link between smoking and disc degeneration.
- Maintain a healthy weight. Less weight is less stress on your joints and your discs.
- Move more. Walking, strength training, and core strength exercises all help keep your spine strong and flexible.
- Sit less. If you have a sedentary job, find ways to stand more. Try a standing desk or take standing breaks.
Nonsurgical Management of Back or Neck Pain
There are several ways to treat degenerative disc disease, depending on the extent and severity of your pain. To start, Dr. Bolinger says he recommends taking a nonsteroidal anti-inflammatory (NSAID) medication and starting physical therapy.
During the first few months, he says it’s also important to:
- Eat a healthy diet. Besides providing nourishment for your body, a well-balanced diet can help you maintain a healthy weight and fitness level.
- Optimize bone mineral density. Eat a diet rich in vitamin D and calcium, or take a supplement.
- Quit smoking.
- Stay physically active. Keep moving each day as much as you can.
- Stretch daily. Take time to stretch your body throughout the day, especially when you first get up and after having spent a long time sitting.
- Try a pain-relieving injection. If your pain doesn’t respond to medications or physical therapy, your doctor may suggest pain-relieving injections.
- Use proper body mechanics. Like your mom always told you: Stand up straight. Bend from your knees and hips. Do not bend over at your waist. Lift the object using your arm and leg muscles. Hold the object close to your body at your waist level.
“Ultimately, moving is what we are supposed to do, so maintaining a healthy level of activity will help stretch, strengthen, and improve your back,” Dr. Bollinger says. “You can’t just stop moving and go to bed rest or your muscles will atrophy.”
Not only will these actions help improve your pain over time, but they also will make you the healthiest you can be should you need surgery down the road. The healthier you are at the time of surgery, the better the potential outcome.
Surgical Options for Back or Neck Pain
If the pain doesn’t improve with conservative treatments, surgery may be an option. “We exhaust all conservative measures before we ever recommend elective spine surgery,” Dr. Bollinger says.
Fortunately there are many minimally invasive and motion-preserving options for those who do need surgery. But sometimes an open surgery is what’s best for a patient.
That is where patients also benefit from the team approach to spine surgery. Dr. Robinson is a double fellowship-trained orthopaedic spine surgeon specializing in robotic and minimally invasive spine surgery. Dr. Bollinger is a board certified neurosurgeon with fellowship training in minimally invasive spine surgery and adult reconstructive spine surgery.
“With multiple surgeons from different backgrounds all looking at one problem, it leads to creative solutions,” he says. “We can put a package of treatments together that is tailored to the specific patient.”
Newer technology also has enabled surgeons to operate with more precision through smaller incisions, which has improved the outcomes of disc replacement surgeries for certain people. This lends itself to patients returning to their day-to-day lives more quickly.
“Although not everyone is a good candidate for certain procedures, we’ll always walk patients through all the options,” Dr. Robinson says. “People shouldn’t be in chronic pain, and we want to help. So, above all, don’t give up.”
Editor's Note: This article was originally published on , and was last reviewed on .