Degenerative Disc Disease

Degenerative disc disease (DDD) is a relatively common condition in aging adults. Our intervertebral discs serve as shock absorbers for the spine, and as we age they gradually dry out, losing strength and resiliency. These changes are gradual in most people. In fact, most people do not know they have degenerative disc disease. Only a portion of the general population actually becomes symptomatic from their condition.

The figures above demonstrate the difference between normal (left) and severely degenerated (right) lumbar discs.
*With permission © 2002 - Dr. Douglas M. Gillard DC

Symptoms

Disc degeneration in itself is not usually a problem; it is part of the normal aging process. However, DDD may, in some individuals, lead to chronic, mechanical low back pain. Some health care professionals will label this condition "Internal Disc Disruption Syndrome (IDDS)".

Internal Disc Disruption Syndrome (IDDS)

This type of pain is also called "Discogenic Pain" or "Mechanical Back or Neck Pain". This refers to pain arising from within the disc and not the adjacent neural tissue. Just because your MRI was deemed "normal" by your doctor does NOT always mean that your back or neck pain is not coming from problems within that very disc. This is especially true if your supposedly normal MRI demonstrates a "bulge" and/or "black" appearing disc on the radiologists report.

What the MRI does not show are discrete tears within or through the fibrous rings of connective tissue (annulus fibrosus) inside the disc. This can lead to irritation of nerve endings within this fibrous ring, resulting in back or neck pain.

          
Fig. 1 Cross-section of normal disc anatomy. Note the annular rings (green) around the central nucleus (pink)
Fig. 2 Cross-section of an abnormal disc demonstrating concentric (white arrows) and radial (red arrow) tears in the annulus.
*With permission © 2002 - Dr. Douglas M. Gillard DC

Diagnosis

MRI of the lumbar spine showing multilevel degenerative disc disease (DDD). Note the loss of hydration demonstrated at L3-4 and L4-5.

After reviewing your MRI, listening to your history and performing a proper physical exam, your physician may form a strong suspicion that you are suffering from IDDS. However, there is no way for your physician to be 100% certain that your back or neck pain originates from the intervertebral disc(s) in your spine from this clinical assessment alone.

In specific cases you may be recommended for a test called discography to confirm the diagnosis. This test involves injecting contrast dye into the affected disc (or discs) to create a clearer image. Because this diagnostic procedure can be uncomfortable it is only performed to crystallize your diagnosis prior to undergoing more invasive treatments such as intradiscal modulation or open surgery.

Most likely, your physician will rule out other common causes of back or neck pain, first. A second common source of pain is the small joints of your back or neck, called the facet joints ("z-joints", "zygapophyseal joints"). Another common source of low back pain that may mimic IDDS is the sacroiliac joint If it is determined the facet joints or sacroiliac joint(s) are the true source of your back pain, you may be a candidate for minimally invasive care to treat these conditions.

Non-operative Treatment

There is no cookie-cutter approach to the treatment of internal disc disruption syndrome (IDDS). The initial management typically consists of a minimally invasive treatment plan utilizing a combination of treatments over a 6 to 8 week period:

• Exercise prescription
• Appropriate anti-inflammatory medication
• Spinal Injections
• Lifestyle modification
• Ergonomic assessment

If your pain fails to improve with this initial treatment plan, you may be a candidate for an 'Intradiscal Modulation' procedure. Intradiscal Modulation is a type of radiofrequency procedure performed for the treatment of IDDS. Simply put, this involves the insertion of a radiofrequency probe into the back of your disc where the painful nerve endings are located. Then electrical energy is used to 'turn off' the nerve endings, thus decreasing the sensation of pain from your disc. For the lumbar and thoracic spine, there are currently three types of "Intradiscal Modulation' procedures available in North America:

• Intradiscal Electrothermal Therapy (IDET)
• Posterior Radiofrequency Ablation (PRFA)
• Biacuplasty

There are very strict criteria determine whether a patient is a candidate for Intradiscal Modulation. It is not an option for all patients with IDDS.

Surgical Treatment

If symptoms of IDDS persist despite these non-operative treatments, further diagnostic tests may be necessary. These tests may include an MRI, CT Scan, myelogram, and possibly discography. If applicable, Dr. Helper will help guide you to the most appropriate spine surgeon for your condition.

Video: Degenerative Disc Disease

Click below to view a video from our library about this condition.