Definition of Degenerative Disc Disease (DDD)

Degenerative Disc Disease refers to a syndrome in which a painful disc causes chronic pain. The condition generally starts in the disc space. A weakened intervertebral disc can create excessive motion in the adjoining vertebral level because the disc cannot hold the vertebral segment together as well as it used to. The excessive motion and the inflammation inside the exposed disc irritate the local area and produce back pain. Unlike the muscles in the back, the disc does not have a blood supply and therefore cannot heal itself, leaving the painful symptoms of degenerative disc disease to become chronic. While it is rare that low back pain from degenerative disc disease will progress or increase, the pain will tend to fluctuate and at times may become significantly worse. It is important to note that disc degeneration is part of the natural process.

How Discs Degenerate

Long before Degenerative Disc Disease can be seen on an MRI, biochemical and histologic changes may have occurred. Some of these changes are not unlike those associated with osteoarthritis. Over time the collagen (protein) structure of the outer wall of the intervertebral disc, also called the annulus fibrosus, weakens and may become structurally unsound. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc’s inability to handle mechanical stress. Because the lumbar spine carries a large portion of the body’s weight the stress on the annulus fibrosus from motion may result in a disc problem (e.g. herniation).

Lumbar Degenerative Disc Disease

Lumbar Degenerative Disc Disease (DDD) is a gradual process that commonly compromises the lumbar spine. Degenerative changes in the lumbar spine often cause the loss of normal structure and/or function. The intervertebral discs in the lumbar spine are structures prone to the degenerative changes associated with wear and tear, aging, and misuse (e.g. smoking).

Cervical Degenerative Disc Disease

Degenerative disc disease is much less common in the cervical spine than in the lumbar spine because there is substantially less torque and force across the cervical spine. Sometimes, however, there is a twisting injury to the disc space that starts the degenerative cascade of degenerative disc disease and leads to chronic neck pain.

Treatment options

Often, degenerative disc disease can be successfully treated without surgery. One or a combination of treatments such as physical therapy, chiropractic manipultive therapy (CMT), osteopatic manipulation, anti-inflammatory medications such as nonsteroidal anti-inflamatory drugs, chiropractic treatments, traction, or spinal injections often provide adequate relief of these troubling symptoms.
Surgery may be recommended if the conservative treatment options do not provide relief within two to three months. If leg or back pain limits normal activity, if there is weakness or numbness in the legs, if it is difficult to walk or stand, or if medication or physical therapy are ineffective, surgery may be necessary, most oftenspinal fusion. There are many surgical options for the treatment of degenerative disc disease. The most common surgical treatments include:
Intervertebral disc annuloplasty (IDET): A procedure wherein the disc is heated to 90°C for 15 minutes in an effort to seal the disc and perhaps deaden nerves irritated by the degeneration.
Anterior cervical discetomy and fusion: A procedure that reaches the cervical spine (neck) through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone or other graft substitute, and in time, that will fuse the vertebrae.
Cervical corpectomy: A procedure that removes a portion of the vertebra and adjacent intervertebral discs to allow for decompression of the cervical spinal cord and spinal nerves. Abone-graft, and in some cases a metal plate and screws, is used to stabilize the spine.
Facetectomy: A procedure that removes a part of the facet to increase the space.
Foraminotomy: A procedure that enlarges the vertebral foramento increase the size of the nerve pathway. This surgery can be done alone or with a laminotomy.
Laminoplasty: A procedure that reaches the cervical spine from the back of the neck. The spinal canal is then reconstructed to make more room for the spinal cord.
Laminotomy: A procedure that removes only a small portion of the laminato relieve pressure on the nerve roots.
Micro-discectomy:  A procedure that removes a disc through a very small incision using a microscope.
Percutaneous disc decompression: A procedure that reduces or eliminates a small portion of the bulging disc through a needle inserted into the disc, minimally invasive.
Spinal decompression: A non-invasive procedure that enlarges the Intra Vertebral Foramen (IVF) by aiding in the rehydration of the spinal discs.
Spinal laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.