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Degenerative Disc Disease Illustration
Degenerative Disc Disease
Degenerative Disc Disease (DDD) is the gradual degeneration of the
discs that reside between the vertebrae in the spine.

The discs in the spine act as shock absorbers for our entire body weight. These discs break down over
time. It is very common because it is a natural part of aging. A disc herniation or bulging disc can cause
pain and/or numbness by extruding into the spinal canal.

The degenerative disc then causes chronic back pain by compressing the nerve roots and giving the spinal
cord and nerves less room to function normally. There is no cure for Degenerative Disc Disease. In fact,
“disease” is a bit of a misnomer in this case because disc degeneration is a normal part of the aging process.

Degenerative Disc Disease

North American Spine can treat the pain symptoms associated with DDD.

The AccuraScope procedure allows our partner physicians to first pinpoint the exact source or sources of chronic back pain, which is a critical step in proper treatment.

The procedure, using a laser and other tools, is then designed to shrink the bulges and seal the cracks of the degenerative disc. This can halt or slow continued degeneration and the inflammatory process which is causing the pain and symptoms.

By eliminating most or all of the pain associated with DDD, the patient is allowed a better quality of life.

“I am now able to go back to the gym 5 days a week…”

Jerry P., Age 49, Location: CO. Diagnosis: Multilevel Degenerative Disc Disease affecting the disks between L3-4, L4-5, L5-S1. Herniated disks with annular tears causing nerve inflammation and lower back pain.

Post-Surgery Outcome:I was given a prescription for pain medicine that I filled after the surgery, but I never needed to take it. In fact, my wife and went to dinner that night after the surgery. As each day passed, the surgery pain got less and after about 14 days, I was totally pain free. Seven days after the surgery I began walking on my lunch break and within two days, I was up to 3 miles. I am now able to go back to the gym 5 days a week and I just started to jog again after getting away from it for ten years. I no longer take ibuprofen and I continue to be pain free. I totally recommend this surgery and I have to say for a medical procedure it was a pretty good experience.

Degenerative Disc Disease Information

Degenerative Disc Disease Basics
Degenerative Disc Disease (DDD), or spondylosis, is the gradual degeneration of the discs that reside between the vertebrae in the spine. Like other joints in the body, the discs in the spine contain cartilage and act as shock absorbers for our entire body weight. Over a lifetime of wear and tear, the cartilage can weaken, gradually causing the discs to degenerate. Disc degeneration can occur anywhere in the spine, from the neck (cervical spine) to the lower back (lumbar spine).

About Degenerative Disc Disease

Known in the medical community as spondylosis, what most people call “degenerative disc disease” actually isn’t a disease at all – it’s a condition characterized by the gradual deterioration of the cartilage inside the spine’s intervertebral discs. Consider how much wear and tear your spine endures over the years – bending, twisting, bearing weight – and it’s no surprise that with time, these discs and their shock-absorbing cartilage begin to break down. Without the cushion these discs provide, you may begin to experience pain and stiffness in your neck or lower back.

While many people will experience some degree of disc degeneration as they age, a more rapid deterioration can lead to lifestyle-limiting symptoms, including sudden or gradual pain. To ensure that you receive the appropriate diagnosis and treatment plan for your spine condition, see your physician before embarking on a self-treatment plan.

How it Causes Pain

Once the disc tissue has begun to break down, the disc itself becomes vulnerable to other conditions, such as disc herniation. When a disc is herniated or ruptured, it can compress the nerve roots and potentially the spinal cord, causing an array of symptoms from numbness, pain, tingling or burning to pain and muscle weakness.
 
 

Degenerative Disc Disease Prevention
Can degenerative disc disease be prevented? Even with a genetic predisposition to degenerative disc disease, you can take steps to keep your spine healthy and strong. Physical activity plays an important role not only in maintaining strength and flexibility, but also in managing excess weight that can place undue stress on the spine. Cigarette smoking also is known to contribute to the weakening of the bones, so if you currently smoke, consider a smoking cessation program.

Here are a few other things to consider.

Posture: If your mother repeatedly nagged you to stand up straight, with your shoulders back, or to sit up straight – no slouching – she was very wise indeed. Maintaining proper posture whether standing or sitting is critical in keeping your back and abdominal muscles strong and able to protect your spine as it ages. If you sit for long periods of time, get up frequently to stretch and move around.

Body Mechanics: You may think you that box of books is a manageable load, but take care to use your legs and knees when moving heavy or cumbersome objects so that the weight is evenly distributed through the body. Similarly, watch your body position even when you’re lounging; the spine should be kept in a “neutral” position with lower back and neck properly supported. And when you’re sleeping, be sure your mattress and pillow are properly supporting your neck and spine. Side-sleepers can keep their spines aligned by placing a pillow between the knees.
 
 

Symptoms of Degenerative Disc Disease
Every person’s spine is unique, so no two people will experience exactly the same symptoms with degenerative disc disease. Similarly, while this condition typically is associated with aging, younger people also can be diagnosed with degenerative disc disease. (See Causes for more information.)

In its early stages, degenerative disc disease presents itself fairly subtly; you may experience mild discomfort or stiffness in your lower back after you’ve been sitting, standing or reclining for a while.

As it progresses, you may feel more insistent symptoms such as sharp, sudden pain or increased levels of chronic pain related to the inflammation around the spine. In many cases, the back will go into spasms because the muscles supporting the back are working hard to stabilize the vertebrae; the discs aren’t doing the job because they have become too weak.

The outer wall of the disc, called the annulus fibrosus, contains nerve fibers that also can become irritated if the disc is herniated and its core materials have begun to leak out. If you’re experiencing pain that radiates from your back to other parts of your body, or you feel weakness, numbness or tingling in your upper or lower extremities, you may have a herniated or bulging disc.

Degenerative disc disease can develop in any part of the spine: the neck (cervical degenerative disc disease), the middle back (thoracic degenerative disc disease) or the lower back (lumbar degenerative disc disease).

Causes of Degenerative Disc Disease
As we get older, the cartilage inside our spine’s disc and vertebrae weakens in part from ongoing use but, also, due to changes in the composition of the cartilage itself. When the cartilage starts to break down, the cushioning it used to provide between your discs and joints becomes less effective. The result? Bone begins to rub against bone, leading to irritation and inflammation that can make regular activities like walking, sitting, bending or sleeping very painful. When the cartilage in your spinal discs starts to deteriorate, it is called spondolysis or degenerative disc disease.

Once it has begun, degenerative disc disease can progress and ultimately may affect the nerves in the spinal column. Without the shock-absorbing benefits of healthy intervertebral discs (comprised mainly of cartilage), the joints in your spine (facet joints) cannot move the way they used to. As part of degenerative disc disease, many patients develop bone spurs in the spinal column. Simply put, the body is trying to give the spine extra protection by generating new bone, but these bone spurs actually cause more problems by irritating and even compressing spinal nerves.

Degenerative disc disease also can be hereditary.

Causes: Lumbago
Physicians use the word “lumbago” to describe general pain in the lower back. Because the lower back consists of muscles, ligaments, bones, joints, discs and nerves, any number of conditions can contribute to lower back pain.

More than half of the American population will suffer some form of back pain in their lives, with the likelihood increasing as a people age. In addition to the wear and tear we impose on our lower backs over the years, injuries (such as sprains, strains or fractures) obviously will contribute to back pain, as will any structural issues (such as a herniated disk).

If you experience tingling or numbness through your buttock and down your leg, your sciatic nerve likely is being compressed leading to an assortment of symptoms known as “sciatica.” Depending on how much pressure is being placed on your sciatic nerve, you also may experience either a constant dull pain or sporadic shooting pain, typically on one side of your lower body.

Whether your pain is situational – you strained your back while exercising – or chronic, it is important to see your physician for an accurate diagnosis. In most cases, physicians will start with a conservative course of treatment, including anti-inflammatory medications, hot/cold compresses, rest and careful exercise, to help ease symptoms while strengthening the back to prevent future pain.

If conservative treatment does not prove effective after a reasonable amount of time, you may want to explore other minimally invasive treatments to help alleviate your symptoms and recover your quality of life. At North American Spine, our experts employ various minimally invasive surgical procedures designed to provide optimal outcomes while significantly reducing the recovery period and risks associated with traditional open-back surgical procedures.


Causes: Spondolysis
Arguably the hardest-working structure in the body, the spine endures its share of use – and sometimes, abuse – over the years. When the structure and function of the spine begin to weaken, spondolysis usually is to blame. Whether in the neck (cervical), mid-back (thoracic) or lower back (lumbar) regions, spondylosis means that the discs between the vertebrae of the spine have begun to deteriorate. These intervertebral discs help the vertebrae absorb the shock of daily movement. These discs consist, in part, of cartilage, which often loses moisture as we age, causing the cartilage and discs to weaken. With less ability to cushion the vertebrae, the deterioration of the discs can cause pain and other symptoms including:

  • Stiffness
  • Diminished coordination and difficulty walking
  • Tingling, numbness or muscle weakness in the arms, hands, legs, or feet
  • Abnormal reflexes

As these symptoms can indicate spondylosis as well as other spinal abnormalities, it is important to consult a physician for a thorough examination and proper diagnosis before commencing treatment.

In most cases, physicians will start with a conservative course of treatment, including anti-inflammatory medications, hot/cold compresses, rest and careful exercise, to help ease symptoms while strengthening the back to prevent future pain.

If conservative treatment does not prove effective after a reasonable amount of time, you may want to explore other minimally invasive treatments to help alleviate your symptoms and recover your quality of life. At North American Spine, our experts employ various minimally invasive surgical procedures designed to provide optimal outcomes while significantly reducing the recovery period and risks associated with traditional open-back surgical procedures.


Causes: Thinning Disc
Your intervertebral discs, designed to serve as shock absorbers for your spinal vertebrae, are composed of cartilage that consists of protein and water. With time, the composition of your cartilage can change as a normal result of aging; the cartilage begins to dry out, making it weaker and more vulnerable to deterioration and “thinning.” We don’t always know this is occurring, even if we have degenerative disc disease, until pieces of the disc dislodge and begin to impinge on spinal nerves, causing a host of symptoms including pain, tingling, numbness, or loss of muscle strength.

If disc debris dislodges and moves into spaces where nerve roots travel from the spinal cord to the rest of our body (the “foramina”), it can compress the nerve’s regular space and put pressure on nerve roots. This crowding of the nerves interferes with the nerves’ normal ability to send signals to the result of the body, creating symptoms like numbness, tingling, muscle weakness, abnormal reflexes or even pain.

Because it has lost some or all of its normal cushion, a thinning disc also makes it possible for the bony vertebrae that flank the disc to rub together, bone on bone. The body’s protective response is to generate more bone in the form of bone spurs (osteophytes), which actually worsen the problem by further crowding the spinal nerves.

When this happens, you may experience:

  • Localized pain in the neck, mid-back or lower back
  • Sciatica
  • Muscle weakness
  • Numbness and/or tingling in the arms, shoulders and hands or buttocks, legs and feet
  • Radicular pain along the pinched nerve

With proper diagnosis and treatment, you can find relief from the symptoms caused by thinning disc.

After a thorough physical examination, your physician will likely order diagnostic imaging – MRI or CT scan — to get a full picture of the structural condition of your spine.

If he/she concludes that you have a thinning disc or other issues caused by degenerative disc disease, typically he/she will start with a conservative course of treatment, including anti-inflammatory medications, hot/cold compresses, rest and careful exercise, to help ease symptoms while strengthening the back to prevent future pain.

If conservative treatment does not prove effective after a reasonable amount of time, you may want to explore other minimally invasive treatments to help alleviate your symptoms and recover your quality of life. At North American Spine, our experts employ various minimally invasive surgical procedures designed to provide optimal outcomes while significantly reducing the recovery period and risks associated with traditional open-back surgical procedures.


 
 
Diagnosing Degenerative Disc Disease
While a physician can diagnose degenerative disc disease fairly easily by taking a medical history, conducting a physical examination and possibly ordering diagnostic tests such as X-ray or MRI, many people will not seek treatment until their pain has become intolerable.

Degenerative disc disease typically progresses very slowly and, many people who have reached middle age take as a given that with time, they will begin to experience stiffness, aches and pains in their back. When mild discomfort progresses to shooting pain, tingling, numbness or muscle weakness, it is important to see your physician to seek proper diagnosis and treatment.

Often, a physician can diagnose disc deterioration through a simple physical examination including palpation (manipulation) of the affected area to determine if the discs are unstable. From there, he/she likely will take a full history of your symptoms and conduct a neurological examination to evaluate your muscle strength and reflexes. Finally, he/she may order diagnostic imaging that could include X-ray, MRI or CT scan and that would show any spinal or tissue abnormalities including fracture, disc herniation, collapse or rupture, and nerve compression.

Why An MRI Scan Is Important

The best way for a physician to properly diagnosis a herniated disc in your spine is through magnetic resonance imaging, or MRI, which will take detailed, two-dimensional pictures of your spine, organs, muscles and soft tissue. This detailed view gives your physician the “full picture,” which leads to a more accurate diagnosis and a more effective treatment plan. MRI scans are used regularly to diagnose neck and spine conditions.

If you have never had an MRI scan, there are a few things you should know:

  • You won’t be subjected to radiation, and you won’t feel any pain
  • Only the “problem area” is scanned
  • The results are extremely accurate

If your physician requests an MRI scan to confirm diagnosis, this will involve your lying in an MRI machine, which looks like a tube, for up to an hour while the designated areas of your back are scanned. It will feel a bit tedious, but you should not experience any discomfort.

The radiologist and your physician will evaluate the images of the damaged disc as well as the muscles and tissues around it; often, the cause of the herniation can be determined as well. From there, you and your physician will decide if a conservative treatment plan is most appropriate, of surgery represents the most effective solution.
 
 

Degenerative Disc Treatment
In most cases, physicians will start with a conservative course of treatment for degenerative disc disease, including anti-inflammatory medications, hot/cold compresses, rest and careful exercise, to help ease symptoms while strengthening the back to prevent future pain.

If conservative treatment does not prove effective after a reasonable amount of time, you may want to explore other minimally invasive treatments to help alleviate your symptoms and recover your quality of life. At North American Spine, our experts employ various minimally invasive surgical procedures designed to provide optimal outcomes while significantly reducing the recovery period and risks associated with traditional open-back surgical procedures.
 
 

Conservative Treatment
Physical Therapy

Whether your physician prescribes physical therapy as part of a conservative treatment plan, or you are preparing for a minimally invasive procedure and recovery, it is important to recognize that physical activity will play a critical role in strengthening your back so you can enjoy continued quality of life.

Degenerative disc disease is a structural manifestation of the aging of the body; the “shock absorbers” we once took for granted now have worn out, causing friction and corresponding pain as bone rubs against bone and nerve roots become irritated.

Physical therapy cannot reverse this damage, but it can play an effective role in managing pain.

Before you begin any physical regimen, be sure to check with your physician so that you don’t further aggravate already inflamed nerves or tissues.

Once you have been evaluated by a physician, however, he/she likely will prescribe some form of physical therapy customized to your unique condition.

Most physical therapy involves several elements which are designed to work in concert to help alleviate pain and aid your mobility. These elements include:

  • Hot and/or cold therapy
  • Spinal traction (to alleviate pressure on the spine)
  • Deep tissue massage to improve blood flow
  • Exercise to make the muscles stronger and more flexible, such as yoga or Pilates
  • Exercises to improve balance and strengthen core (abdominal) muscles
  • Low-impact aerobic exercise such as swimming, walking or cycling to improve your cardiovascular system and pump healing oxygen to the inflamed areas

Though degenerative disc disease is progressive and, as such, cannot be reversed, its symptoms can be managed so that you can continue most of the activities you enjoy. If physical therapy alone does not help alleviate pain and other symptoms, your physician may prescribe medications to help diminish inflammation and/or manage pain.

Medication

Often, over-the-counter pain relievers like ibuprofen will provide relief. Should you suffer extreme inflammation, your physician may prescribe a non-steroidal anti-inflammatory medication and, in the cases of debilitating pain, prescription muscle relaxants. Epidural steroid injections, through which the inflammation-reducing steroid is delivered directly into the affected areas of the spine, are another effective treatment, though they will not provide permanent pain relief.

However, if your degenerative disc disease has progressed past the point of achieving relief from conservative courses of treatment, your best option may be minimally invasive spine surgery. At North American Spine, our experts employ various minimally invasive surgical procedures designed to provide optimal outcomes while significantly reducing the recovery period and risks associated with traditional open-back surgical procedures.


Surgery
While there is no cure for degenerative disc disease, minimally invasive surgery is an effective way to treat its attendant pain. At North American Spine, our highly trained experts often use AccuraScope® Discectoctomy and Neural Compression (D.N.D.) both to diagnose and treat pain and other symptoms associated with spinal stenosis, degenerative disc disease, herniated discs and other lumbar conditions that compress the nerves.

With the AccuraScope D.N.D., our surgeons can identify the sources of your pain through an endoscope, and then minimize the herniation or bulge with instruments including a laser, which also can be used to seal the disc and reduce the risk of future herniation.

Here’s how it works. The surgeon will use a live x-ray for guidance, then make a very small incision at the base of the spine through which an endoscopic fiber-optic scope is in inserted. Resembling a small tube, the scope allows the surgeon to examine the inside of the spinal canal and the lumbar disks to locate any tears, ruptures, herniations, scar tissue, inflammation or other abnormalities that could be causing symptoms. Depending on what he or she finds, the physician then will use various instruments, including a laser, to shrink the damaged disc(s) or scar tissue, remove bone and disc material, or treat the spinal stenosis. The laser’s focused beam of light produces heat used instead of a scalpel to eliminate the extraneous tissues or fragments causing nerve compression. Within 30 to 40 minutes, during which the patient is mildly sedated and the surgical area numbed with a local anesthetic, the surgeon can effectively eliminate the source of pressure on the spinal nerve(s) affected Many patients notice immediate relief as they wait in the recovery area, and are typically discharged one hour after surgery. Patients typically walk the same day of their AccuraScope procedure. Many patients resume normal activities, as well as gentle physical therapy, the day after surgery and most can return to work within a week of the procedure.

One of several types of minimally invasive spine surgery, AccuraScope delivers several important benefits to our patients. First, the surgery is less invasive, which means fewer incisions, fewer chances of infection, less post-surgical pain and a faster recovery. Second, it eliminates risks associated with general anesthesia, as the patient is awake (though mildly sedated) during the procedure, allowing the surgery to talk with the patient during the procedure. And the procedure is performed on an outpatient basis, meaning no hospitalization time. Third, no hospitalization is required – the surgery is performed on an outpatient basis.


What makes AccuraScope different?
Before considering minimally invasive spine surgery, it is important to realize that not all spine surgery techniques are equal. In fact, some “minimally invasive” techniques are anything but: they may damage and/or remove healthy tissue, or even worsen degenerative disc disease, which could result in the need for future procedures to correct the damage. Because the AccuraScope includes the use of a real-time x-ray, surgeons can see what is happening in the spine at that moment, rather than having to rely on a dated MRI whose images may not clearly depict the source(s) of the problem.

Unlike other types of minimally invasive surgery, the AccuraScope also allows surgeons to treat more than one area of the spine at a time, eliminating the need for multiple procedures. In addition, the AccuraScope is the only minimally invasive procedure through which surgeons can remove scar tissue; unless patients elect to undergo open back surgery, which requires hospitalization, general anesthesia and a lengthy incision that complicates recovery, AccuraScope is the preferred procedure to eliminate scar tissue that could be causing pain.

Many surgeons still perform traditional spine surgery, or “open spine surgery,” despite the sophistication and proven effectiveness of minimally invasive spine surgery in diagnosing and treating spine conditions. While every patient’s circumstances are unique, open spine surgery involves numerous risks that most patients can avoid by electing minimally invasive surgery. Open spine surgery, by its nature, is very invasive: the surgeon must cut through skin, muscle, ligaments, bones, blood vessels, nerves and normal disc tissue before even starting to correct the source of the patient’s symptoms. Because of the trauma imposed on the body during open spine surgery, hospitalization is required. Recovery can be very long and very painful. Patients may develop significant scar tissue, which introduces new problems. And the success rate is considerably lower than what minimally invasive procedures deliver.

Comparison Chart:

D.N.D. Surgery

Other Minimally Invasive Surgery

Traditional Spine Surgery

Success:

Extremely High

Moderate

Variable

Diagnostic Value:

Extremely High

None

None

Risk:

Very Low

Low

Moderate

Recovery:

Days/Weeks

Weeks

Months

Internal Scarring/
Greater Pain:

Minimal Risk

Minimal Risk

Significant Risk

Tissue Damage:

Little to None

Moderate/Significant

Extensive

Anesthesia

Monitored Sedation

Variable

General Anesthesia

At North American Spine, our expert surgeons use an evidence-based approach to tailor treatment plans to the unique needs of each patient. Whether the prescribed course of treatment is epidural steroid injections, AccuraScope (D.N.D.) procedures, mildTM procedures, minimally invasive fusions or even open back surgery, our surgeons are committed to practicing the most conservative but most effective medicine necessary to maximize our patients’ quality of life. They continually refine their techniques based on independent, peer-reviewed research to ensure that North American Spine patients receive the best of what technology and compassionate care can provide.

North American Spine is the exclusive provider of the Accurascope D.N.D.


Get Started Today
North American Spine works with leading spine experts who specialize in the diagnosis and treatment of conditions like sciatica. The first step is to register for more information. You will be assigned to a patient coordinator who will be able to review your medical history, answer your questions and guide you through the journey toward relief.

The second step is to submit your MRI or CT scan report for a free review. This will allow the medical team at North American Spine to understand your condition and provide a recommendation – which may or may not include a minimally invasive treatment like the AccuraScope procedure or one of the many other procedures offered by North American Spine. If you haven’t had a recent MRI, you can request one from your primary care physician.

If you know you have degenerative disc disease, the next best step is to know your options for treating it.

Fill out the form on this page to get started.